Tonsillar metastasis in hepatocellular carcinoma patients may present as undifferentiated carcinoma with specific IHC markersLenvatinib and Chemoembolization Treatment Linked to Liver Cancer Metastasis

Frontiers in Medicine Published September 30, 2026 DOI ↗ Editorial oversight: Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

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Key Takeaway

Note that a multi-marker panel is critical for diagnosing tonsillar masses in HCC patients to avoid misdiagnosis.

This case report and literature review describes a single 84-year-old male patient with chronic hepatitis B and right-lobe hepatocellular carcinoma who presented with a tonsillar mass. The report focuses on the pathology and immunohistochemistry profile of the lesion to determine its origin.

The tonsillar mass was identified as an undifferentiated carcinoma lesion. Immunohistochemistry of the tonsillar metastasis showed a loss of Hep Par-1 and Arginase-1, while Glypican-3 and HSP70 were retained. The Ki-67 index was reported at 80%.

The authors note that the study is limited by a small sample size as it is a single case report. Clinical implications suggest that any unusual head and neck lesion in patients with hepatocellular carcinoma should raise suspicion of metastasis. The authors emphasize that a multi-marker panel is critical for diagnosis because the loss of Arginase-1 does not rule out a primary hepatocellular carcinoma origin.

How this fits prior evidence

This case report addresses a gap in the clinical recognition of metastatic sites in hepatocellular carcinoma. While other covered evidence focuses on predictive models for microvascular invasion, the role of the CALLY index in survival, or the use of exosomal miRNAs as biomarkers, this report provides specific diagnostic insights for identifying metastatic lesions in the head and neck region.

A case report describes an 84-year-old man with chronic hepatitis B and a liver tumor. The patient received a combination of transarterial chemoembolization and lenvatinib. During the course of treatment, a mass was found in his tonsil area.

Testing of the tonsil mass revealed it was an undifferentiated carcinoma. Specific markers showed the tumor lost Hep Par-1 and Arginase-1, while keeping Glypican-3 and HSP70. The Ki-67 index was 80 percent. This finding suggests that liver cancer can spread to the head and neck region.

Because this is a single case report, the findings are not enough to change standard medical practices. However, it serves as a reminder for doctors to check for unusual lumps in the head or neck of patients with liver cancer. A multi-marker panel is recommended because losing one specific marker does not rule out a liver cancer spread.

What this means for you:

A single case shows liver cancer can spread to the tonsils, requiring careful monitoring of head and neck symptoms.

Common questions

Can liver cancer spread to the throat or tonsils?

Yes, this case report describes a situation where an 84-year-old man with liver cancer had a tumor in his tonsil area. While this is a single case, it shows that liver cancer can spread to the head and neck. Doctors should look for unusual masses in these areas for patients with liver cancer.

What markers were found in the tonsil tumor?

The tonsil mass was tested using immunohistochemistry. It lost Hep Par-1 and Arginase-1, but it kept Glypican-3 and HSP70. The Ki-67 index was 80 percent. These tests help doctors identify the type of cancer and see if it spread from the liver.

Is this finding common for patients taking lenvatinib?

This information comes from a single case report and a literature review, not a large study. Because it is only one case, we cannot say how common this is for other patients. You should talk to your doctor about how these findings apply to your specific treatment plan.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedSep 2026

View Original Abstract ↓

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.

Tonsillar metastasis in hepatocellular carcinoma patients may present as undifferentiated carcinoma with specific IHC markersLenvatinib and Chemoembolization Treatment Linked to Liver Cancer Metastasis

How this fits prior evidence

Common questions

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Tonsillar metastasis in hepatocellular carcinoma patients may present as undifferentiated carcinoma with specific IHC markersLenvatinib and Chemoembolization Treatment Linked to Liver Cancer Metastasis

How this fits prior evidence

Common questions

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