Hepatocellular carcinoma first presenting with metastasis to the parotid gland: review of literature with case demonstration

Abstract Background Hepatocellular carcinoma is the most common primary hepatic cancer. It can spread to several distant sites including bones and the adrenals but has also been described to spread to other organs such as the heart, ovary, pharynx, and orbit. We report on a patient in whom metastatic spread to the parotid gland was the presenting feature. Case presentation A 49-year-old male with a history of hepatitis C presented with a right-sided facial swelling. Evaluation revealed it to be metastatic from an undiscovered hepatocellular carcinoma in the right liver lobe, with further metastases to the vertebral column. Hepatocellular carcinoma can arise on top of liver cirrhosis and is associated with a lower survival in these cases. The diagnosis of hepatocellular carcinoma in the liver can be made based on radiological findings, but cytology and using immunohistochemistry can help diagnose metastases in other sites. Markedly elevated alpha-fetoprotein can indicate advanced disease. It is important to maintain a low threshold of suspicion in all patients with malignant disease, especially those with known risk factors, even if they present with a seemingly unrelated complaint. Conclusion Proper evaluation and systematic clinical thinking are necessary to make sure rare presentations of disease are not misdiagnosed.