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Hepatocellular carcinoma (HCC) metastasizes to themandible is infrequently seen. Solitary bony metastasis tothe mandible is rarer. The intractable bleeding caused byrupture of the metastatic HCC is challenging to clinicians.We present a case of a 74-year-old woman with HCCunder control without progression for 3 years. Left facialswelling and episodes of bleeding developed recently andbiopsy revealed a metastatic HCC. Computer tomographyshowed a large tumor in parapharyngeal space withevident mandibular ramus destruction. Bleeding occurredfrom the metastatic tumor but could not be controlledby electrocauterization, Surgicel?, tissue glue, andbone wax and angiographic embolization. Palliativeradiotherapy (2400 cGy in 6 fractions) was tried andthe intractable bleeding was successfully stopped afterthe radiotherapy. Because of the hypervascular andosteolytic nature of the solitary mandibular metastaticlesion, the bleeding was troublesome. Radiotherapyprovided successful control of intractable bleeding fromthe metastatic tumor.
The intractable bleeding caused by rupture of the metastatic HCC is challenging to clinicians. We present a case of a 74-year-old woman with HCC under control without progression for 3 years. Left facialswelling and episodes of bleeding recently recently andbiopsy revealed a metastatic HCC. Computer tomographyshowed a large tumor in parapharyngeal space withevident mandibular ramus destruction. Bleeding occurredfrom the metastatic tumor but could not be controlledby electrocauterization, Surgicel®, tissue glue, and bone wax and angiographic embolization. Palliative radiotherapy (2400 cGy in 6 fractions) was tried and the intractable bleeding was successfully stopped afterthe radiotherapy. Because of the hypervascular andosteolytic nature of the solitary mandibular metastaticlesion, the bleeding was troublesome. Radiotherapyprovided successful control of intracta ble bleeding fromthe metastatic tumor.