case_images: PMC9619851_01
case_images: Photographs of patient before treatment demonstrating exophytic hard palate
  mass (A); after treatment the mass is no longer grossly visible (B).
case_images: 10.1177_23247096221133989-fig1.jpg
case_images: PMC9619851_01_10.1177_23247096221133989-fig1.jpg
case_images: fig1-23247096221133989
case_images: A 32-year-old woman was referred to the oral surgery department at our institution for a painful hard palate mass (Figure 1A). On follow-up 1 month after radiotherapy was completed, she reported palliative benefit and demonstrated local tumor control along the hard palate where the tumor was no longer visible (Figure 1B).
case_images: (A) CT maxillofacial coronal image demonstrating tumor extending into the
  left aspect of the nasal cavity from the palate (white arrow). (B) PET scan
  demonstrating multifocal hypermetabolic masses within the cirrhotic liver.
  Ascites is present (white arrow).. Abbreviations: CT, computed tomography; PET, positron emission
  tomography.
case_images: 10.1177_23247096221133989-fig2.jpg
case_images: PMC9619851_01_10.1177_23247096221133989-fig2.jpg
case_images: fig2-23247096221133989
case_images: ALT (alanine transaminase) were unremarkable. Alkaline phosphatase was 113 IU/L. A maxillofacial computed tomography (CT) showed a 3.6 x 3.2 cm2 heterogeneous mass centered along the anterior aspect of the hard palate with penetration into the left nasal cavity (Figure 2A). Subsequent positron emission tomography (PET) CT skull to mid-thigh showed additional findings including cirrhotic appearing liver with ascites and multiple hypermetabolic hepatic masses (Figure 2B).
case_images: (A) Ulcerated hard palate metastatic tumor (hematoxylin-eosin, 40x). (B) Hard
  palate tumor with trabecular and nesting patterns (hematoxylin-eosin, 100x).
  (C) Hard palate tumor diffusely strongly positive for albumin in situ
  hybridization (40x). (D) Hard palate tumor focally weakly positive for
  arginase immunostain (100x). (E) Hepatocellular carcinoma with adjacent
  liver tissue (hematoxylin-eosin, 100x). (F) Hepatocellular carcinoma with
  trabecular pattern (hematoxylin-eosin, 400x). (G) Background liver with
  cirrhosis (hematoxylin-eosin, 100x). (H) Metastatic pelvic tumor
  (hematoxylin-eosin, 100x).
case_images: 10.1177_23247096221133989-fig3.jpg
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case_images: Both biopsies demonstrated a proliferation of tumor cells with eosinophilic to clear cytoplasm in trabecular and nesting patterns (Figure 3E, 3F, 3H). The palate mass biopsy from the outside institution was reviewed and showed similar findings (Figure 3A-3B). AE1/AE3, keratin OSCAR, and CAM5.2; patchy weakly positive for arginase-1 (Figure 3D) and CK7; and negative for PAS-diastase, HepPar 1, glypican3, synaptophysin, chromogranin, DOG-1, S100, and p63. Albumin in situ hybridization (ISH) was strongly diffusely positive within the tumor cells (Figure 3C). The background liver showed cirrhosis with mild steatohepatitis and focal cholestasis (Figure 3G).