Metastatic hepatocellular carcinoma to the sinonasal cavity: A case report and literature review

Abstract

Introduction: Persistent unilateral sinonasal symptoms should be concerning for the presence of a sinonasal mass. Metastatic disease should be on the differential during diagnosis. Case presentation: A 76-year-old woman with a history of non-Hodgkin's lymphoma, alcoholic liver cirrhosis with hepatocellular carcinoma (HCC) status post primary liver resection and allotransplantation presented to the emergency department with one month of persistent right eye swelling. The patient had been treated with antibiotics by an outside provider for presumed bacterial sinusitis. On nasal endoscopy and biopsy, the diagnosis of metastatic poorly differentiated carcinoma with positive hepatocyte paraffin antigen-1 staining was made. Discussion: Sinonasal metastases from distant tumors are uncommon. Metastatic HCC after liver transplantation in this location are even rarer. Post-transplantation metastases to the nasopharynx have only been reported in two other cases. Conclusion: Patients with persistent unilateral sinonasal symptoms should be worked up for possible malignancy, particularly if that patient has a history of cancer. Metastases from recurrent disease in post-transplant patients are likely to increase over the coming decades as medical management of organ recipients improves.