P2453 - A Rare Metastasis of a Rare Disease: Oral Metastasis of Mixed Hepatocellular Carcinoma and Cholangiocarcinoma

Raha Sadjadi, MD¹, Aaron Goldberg, MD², Stacie Vela, MD^3
1University of Arizona College of Medicine, Phoenix, AZ; ²Carl T. Hayden Veterans Affairs Medical Center, Phoenix, AZ; ³University of Arizona College of Medicine-Phoenix, Phoenix VA Medical Center, Phoenix, AZ

Introduction: Oral metastasis of either cholangiocarcinoma or hepatocellular carcinoma is a very rare occurrence. Here we present a patient with mixed cholangiocarcinoma and hepatocellular carcinoma who developed oral metastases of his disease.

Case Description/Methods: A 65-year-old man with a history of hereditary hemochromatosis complicated by cirrhosis, diabetes, hyperlipidemia, and chronic obstructive pulmonary disease presented to the hospital with a few days of epigastric abdominal pain, food intolerance, emesis, and constipation. His vital signs were normal. His calcium was 12.3, alkaline phosphatase 181, aspartate aminotransferase 22, alanine aminotransferase 26, total bilirubin 1.5, lipase 443, and white blood cell count 17.7. Computed tomography (CT) of the abdomen showed pancreatitis and a 9.5cm x 12.8cm x 14.6cm infiltrative hepatic tumor. Magnetic resonance imaging of the abdomen raised concern for hepatocellular carcinoma (HCC) versus a combined HCC and cholangiocarcinoma. He left the hospital prior to tissue diagnosis but returned after outpatient labs showed his calcium was 14.5. He received calcitonin, IV fluids, and zoledronic acid for hypercalcemia treatment. He underwent liver biopsy which confirmed mixed cholangiocarcinoma and HCC. At his outpatient oncology visit he reported he was concerned about a tooth abscess. He was evaluated by oral maxillofacial surgery who determined multiple teeth needed to be removed. At this visit the patient also disclosed that for the prior 2 weeks his gums had been growing over his teeth. He underwent extraction of multiple teeth along with biopsies of his oral soft tissue lesions. Biopsies revealed metastatic adenocarcinoma. The patient passed away one month later.

Discussion: Mixed hepatocellular carcinoma and cholangiocarcinoma is a cancer that shares features of the two separate cancers for which it is named. It is a rare disease with an incidence of 0.4% - 14.2%. A PubMed search revealed no published case reports of oropharyngeal metastasis of this disease. At baseline, this is an aggressive disease with poor long-term outcomes. This case highlights the need to consider obscure metastases when performing cancer staging and prognostication.


Disclosures:


Raha Sadjadi, MD¹, Aaron Goldberg, MD², Stacie Vela, MD³. P2453 - A Rare Metastasis of a Rare Disease: Oral Metastasis of Mixed Hepatocellular Carcinoma and Cholangiocarcinoma, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.