{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:59:33Z","timestamp":1790657973999,"version":"4.1.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Tonsillar metastasis from hepatocellular carcinoma (HCC) is extremely rare. We report an 84-year-old man with chronic hepatitis B who presented with a right-lobe HCC and portal vein tumor thrombosis. Three months after diagnosis, intrahepatic metastases were treated with transarterial chemoembolization and lenvatinib. Twenty-three months later, he developed blood-tinged sputum; imaging and laryngoscopy revealed a left tonsillar mass with concurrent pulmonary and hepatic progression. Tonsillectomy yielded an undifferentiated carcinoma lesion. Compared with the primary tumor, the tonsillar metastasis lost hepatocyte specific antigen (Hep Par-1) and Arginase-1 expression, showed a markedly elevated Ki-67 index (80%), but retained Glypican-3 and heat shock protein 70 (HSP70). A diagnosis of metastatic HCC was favored based on integration of clinical history, laboratory findings, and pathological immunohistochemistry. In HCC patients, any unusual head and neck lesion warrants suspicion of metastasis; a multi-marker panel is critical for diagnosis, as loss of Arginase-1 does not rule out HCC.<\/jats:p>","DOI":"10.3389\/fonc.2026.1901768","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:47:09Z","timestamp":1790657229000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tonsillar metastasis from hepatocellular carcinoma: a case report and literature review"],"prefix":"10.3389","volume":"16","author":[{"given":"Jianhao","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Oncology, The 909th Hospital, School of Medicine, Xiamen University","place":["Zhangzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujuan","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Oncology, The 909th Hospital, School of Medicine, Xiamen University","place":["Zhangzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lusheng","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Pathology, The 909th Hospital, School of Medicine, Xiamen University","place":["Zhangzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuiyu","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Blood Transfusion, The 909th Hospital, School of Medicine, Xiamen University","place":["Zhangzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guomin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, The 909th Hospital, School of Medicine, Xiamen University","place":["Zhangzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.08.021","article-title":"Global burden of primary liver cancer in 2020 and predictions to 2040","volume":"77","author":"Rumgay","year":"2022","journal-title":"J Hepatol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2008.01864.x","article-title":"Extrahepatic metastasis of hepatocellular carcinoma: incidence and risk factors","volume":"28","author":"Kanda","year":"2008","journal-title":"Liver Int"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.2147\/JHC.S429903","article-title":"Survival prediction model for patients with hepatocellular carcinoma and extrahepatic metastasis based on XGBoost algorithm","volume":"10","author":"Lim","year":"2023","journal-title":"J Hepatocell Carcinoma"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14030752","article-title":"Conventional therapies do not prolong the prognosis of hepatocellular carcinoma patients with extrahepatic metastases under receiving of tyrosine kinase inhibitors","volume":"14","author":"Maeda","year":"2022","journal-title":"Cancers (Basel)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000041789","article-title":"Transarterial chemoembolization in hepatocellular carcinoma: exploring its role in vascular invasion and extrahepatic metastasis: a systematic review","volume":"104","author":"Khalid","year":"2025","journal-title":"Medicine"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25960","article-title":"Hepatocellular carcinoma with extrahepatic metastasis: clinical features and prognostic factors","volume":"117","author":"Uchino","year":"2011","journal-title":"Cancer"},{"key":"B7","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1159\/000529182","article-title":"Mandibular metastasis as the first manifestation of hepatocellular carcinoma: a case report","volume":"16","author":"Fern\u00e1ndez-Ferreira","year":"2023","journal-title":"Case Rep Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1996.67.7.717","article-title":"Hepatocellular carcinomas diagnosed following metastasis to the oral cavity. 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