A 54-year-old male patient presented with toothache in relation to an erupted right lower third molar due to this condition in May 2003.
The oral inspection showed the existence of a swelling that expanded the buccal-lingual corticals, in the region of the right mandibular third molar, carious distally.
The oral mucosa was preserved and cervical adenomegaly was not present.
The patient reported the existence of hypoesthesia in the distribution territory of the chin nerve for 15 days.
The orthopantomography showed the presence of a radiolucent image, with poorly defined contours, in the right mandibular body.
Two days later, under local anesthesia, extraction of the third molar and curettage-biopsy of the underlying tissue were performed.
During surgery, there was intense bleeding, which could be co-hidden with the use of Surgicel (Johnson & Johnson, Nuevo Brunswick, alveolar bone) and through the cera.
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The hemogram and post-operative coagulation study showed no significant alterations.
The histopathological diagnosis of the material was: mandibular metastasis from well-differentiated hepatocarcinoma.
Leukocytes were not stained with cytokeratins 19 and 20 or with alpha-fetoprotein, but showed intense granular cytoplasmic staining with hepatocyte marker N.
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The patient's personal history included a history of type II diabetes of 8 years of evolution, controlled with oral hypoglycemic agents.
It was a drinker of 130 g. ethanol/day since the age of 30, and smoker of 2 packs of cigarettes/day since the age of 20.
One year before our evaluation, the patient had been diagnosed with liver cirrhosis (Child Pugh stage A: 5/15), and multicentric hepatocellular carcinoma with involvement of segments II, III, and IV, being operated on by resection.
A complete study including 99-MDP bone scintigraphy and computed tomography of the head, lung, abdomen and pelvis had been previously performed, but no metastases were observed.
Serum alpha-fetoprotein levels were normal in postoperative controls (3.6 ng/ml).
Fifteen days after our intervention we observed an increase in the levels of alpha-fetoproteins (221 ng/ml), left obsessive, magnetic resonance imaging, and bone scintigraphy showed the existence of multiple metastases affecting the body.
The patient underwent radiation therapy for vertebral lesions (10 Gy per week of Co 60) with no improvement, and died six months after our biopsy.
