Hindawi Publishing Corporation Case Reports in Transplantation Volume 2012, Article ID 181242, 3 pages doi:10.1155/2012/181242 Case Report Oral Cavity Metastasis of Hepatocellular Carcinoma following Liver Transplantation Nicol´ as Goldaracena, 1 Mariela Barreto, 2 Gabriel Casas, 2 Margarita Anders, 3 Ricardo Mastai, 3 and Lucas McCormack 1 1 Liver Surgery and Transplantation Unit, Hospital Alem´ an of Buenos Aires, Avenne Pueyrred´ on 1640, Buenos Aires 1118AAT, Argentina 2 Pathology Service, Hospital Alem´ an of Buenos Aires, Avenne Pueyrred´ on 1640, Buenos Aires 1118AAT, Argentina 3 Hepatology Service and Liver Transplantation Unit, Hospital Alem´ an of Buenos Aires, Avenne Pueyrred´ on 1640, Buenos Aires 1118AAT, Argentina Correspondence should be addressed to Lucas McCormack, lmccormack@hospitalaleman.com Received 29 August 2012; Accepted 11 September 2012 Academic Editors: D. Capone, G. Forrest, M. R. Moosa, and M. Sadeghi Copyright © 2012 Nicol´ as Goldaracena et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Liver transplantation (LT) remains the only cure for hepatocellular carcinoma (HCC) in many cases. Over many years, most centers have applied the Milan criteria for selecting cirrhotic patients with HCC for LT. In a new era where several transplant groups are pushing the limits of transplanting HCC outside Milan criteria as an aggressive approach with promising results, we present interesting images of a patient that presented a unique and rare site of HCC metastasis after 36 months of liver transplantation. 1. Introduction Over many years, most centers have applied the Milan selec- tion criteria for cirrhotic patients with hepatocellular carci- noma (HCC). However, several groups from different coun- tries have challenged these restrictive criteria with promising results [1]. This more aggressive approach could result in higher rates of tumor recurrence that should carefully be assessed in these patients with advanced HCC within the liver. We report here a case with an unusual site of tumor recurrence after liver transplantation (LT) that should be known as a potential site of metastasis. 2. Case Report A 58-year-old male patient with liver cirrhosis due to hepati- tis C virus (HCV) infection and alcohol consumption with HCC beyond Milan criteria underwent LT at our unit. The pathological study of the liver specimen revealed multiple well-differentiated HCC with a major nodule of 6,6 cm in diameter without vascular invasion (T3aN0M0). After LT the patient received tacrolimus and mycophenolate as immunosuppression regimen. During follow-up, he never experienced HCV recurrence. In addition, any episodes of rejection or opportunistic infections needing specific treat- ment were detected. Follow-up images and tumoral markers showed no tumoral recurrence until 36 months after LT when he was admitted to our hospital presenting with a 2 cm in diameter bleeding oral mass localized in the retromolar trigonum (Fig- ure 1(a)). The bleeding stopped by local compression, and a biopsy of the lesion was taken. The pathological study of the oral lesion demonstrated mucosal infiltration by a poor- differentiated carcinoma (Figures 1(b) and 1(c)). Immuno- histochemistry was performed and the lesion was positive for Heppar 1 and CD34 (Figure 2). With the morphological features and the immunohistochemical profile the oral lesion was diagnosed as a metastatic HCC. After diagnosing the oral lesion as a metastatic HCC a PET-CT was performed showing no other metastatic