Tonsillar metastasis from HCC

Fig. 3. Histological findings of the tumor (hematoxylin and eosin staining, × 100). The surface tissue is thestratified flattened epithelium, but the inside tissue is of the hepatocellular carcinoma with sinusoidal patterned cells. Immunohistochemical staining of alpha-fetoprotein was negative, but that of carcinoembryonicantigen was positive.

In patients with tonsillar metastases, thelesions are mostly unilateral, but several papers
reported bilateral occurrences (Draizin et al.,
1978; Kadowaki and Ikoma, 1990).
The metastases usually appear within 1 year
after the occurrence of the primary tumor. In
some uncommon cases, however, lesions occuring before the existence of a primary tumor
has been noted, which allows for the definite
diagnosis of the primary tumor (Fernández
Aceñero et al., 1996). Similarly, both the present patient and the patient in San Carlos University Hospital (Llanes et al., 1996) were diagnosed as HCC due on the metastasis to the unilateral palatine tonsil.
The common symptoms of metastatic tumors of the tonsil are pharyngeal discomfort,
pain and bleeding. Because the symptoms are
weak in most cases, the metastases are generally found in the advanced stage. Furthermore,they are usually a late event in the progressionof HCC, so that prognosis is generally poor
once its metastatic lesion is found. Kanazawa
and Sato (1989) explained that the mean surviv-

al rate after the appearance of oral metastases
was 21 weeks, ranging from 2 weeks to 2 years.
The patient in San Carlos University Hospitaldied 8 months after the diagnosis of tonsillar
metastasis.
Major treatment is resection of the tumor bypalatine tonsillectomy. The operation is very
useful for prevention of such complications aspharyngeal pain, dyspnea, dysphagia and severe bleeding (Hando et al., 1995; Yamauchi etTable 1. The primary sites for tonsillar metastases reported in Japan
Primary site

Number of patients

Pulmonary cancer
Gastric cancer
Liver cancer
Colon cancer
Malignant melanoma
Choriocarcinoma
Renal cancer
Breast cancer
Others*Including the present patient.

219

2488*
333224

K. Nakahara et al.

al., 1995). And we should always respect thepatients’ quality of life during treatment because of the poor prognosis.

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(Received August 20, Accepted September 27, 1999)

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