Oral metastasis: a report of 23 cases

Clinicopathological Features of Metastasis to the Oral and Maxillofacial Region-Multicenter Study

BACKGROUND

This study aimed to investigate the clinicopathological features of metastases in the oral and maxillofacial regions.

METHODS

In this retrospective study, biopsy records were obtained from referral centers for oral and maxillofacial diagnosis in Brazil, Guatemala, Mexico, and South Africa.

RESULTS

A total of 120 cases were evaluated. Of these, 53.78% affected female patients, with a mean age of 57.64 years. Intraosseous lesions were more frequent, particularly in the posterior region of the mandible (49.58%). Clinically, most cases presented with symptomatic swelling, with an average evolution time of 25 months. The clinical diagnostic hypothesis in most instances was that of a malignant lesion. Breast cancer was the most common primary tumor location in females, while lung origin was most common in males. In most cases, the primary cancer was an adenocarcinoma (44.73%). The follow-up period was available for 29 cases, and out of these, 20 had died due to the disease.

CONCLUSION

Although this is a rare condition, clinicians should be aware that any oral lesions have the possibility of being metastatic, particularly in individuals with a previous history of cancer. The findings from this study could assist clinicians in prompt diagnosing these lesions and subsequent conducting oncologic assessments and treatment.

The first case report of metastatic rectal adenocarcinoma to the oral vestibule in a young woman

BACKGROUND

The available literature regarding metastasis to the oral cavity from colorectal cancer, especially rectal cancer, is currently limited. With this in mind, we aimed to report the first case of rectal adenocarcinoma metastasis to the oral vestibule.

CASE REPORT

A 36-year-old Caucasian female with a 17-months history of rectal adenocarcinoma and several metastases was referred to the Dental Oncology Service due to a nodular swelling in the oral cavity. Intraoral examination showed a large, painless nodule with superficial necrosis on the right side of the mandibular vestibule. An incisional biopsy was performed, and the microscopic analysis demonstrated an infiltrative tumor characterized by islands of malignant epithelial cells with a columnar appearance and tubular pattern. The epithelial component presented pseudoductal structures resemble intestinal mucosa, which exhibited intraluminal secretion. The neoplastic cells were immunoreactive for CDX2 and Cytokeratin 20, and negative for Cytokeratin 7. Therefore, the final diagnosis of metastatic rectal adenocarcinoma was established. Unfortunately, the patient died 23 months after the diagnosis of the primary tumor.

CONCLUSION

The study highlights that metastases to the oral cavity should be considered in the differential diagnosis of large reactive lesions affecting young patients, especially in the setting of a patient history of cancer.

Oral metastasis as the first indication of undiscovered malignancy at a distant site: A systematic review of 413 cases

This systematic review is the first to provide evidence regarding demographic, clinical, and imaging characteristics, as well as information related to survival, of patients with oral and maxillofacial metastases of occult primary tumors. Case reports, case series, and cross-sectional studies were included. Ten databases were searched. The risk of bias was assessed using the Joanna Briggs Institute appraisal tools. Overall, 353 articles (413 patients) were included. Statistically significant associations between survival and multiplicity of metastatic foci, and between each of the main primary sites and some features of the oral lesions were observed. Some clinical and imaging characteristics can help dentists in raising diagnostic suspicions and also in relating to plausible primary sites. Early diagnosis of oral and maxillofacial metastases can positively affect the survival rate when they are the only focus of dissemination, conferring an important role on the dentist.

Metastatic Tumors to the Oral Soft Tissues and Jawbones: A Retrospective Analysis of 40 Cases and Review of the Literature

BACKGROUND

Metastasis to the oral soft tissues and jawbones is rare and frequently associated with wide spread disease and dismal prognosis. Herein, we report the clinicopathologic characteristics of 40 intraoral metastatic neoplasms and perform a comprehensive review of the pertinent literature.

METHODS

Criteria for inclusion included: (a) archived cases from the UMN Oral Pathology laboratory with available tissue blocks and/or H&E-stained preparations diagnosed between 2003 and 2021, (b) proper documentation of the clinico-radiographic characteristics of oral metastasis along with confirmed history of primary malignancy, or (c) microscopic findings consistent with metastatic disease with or without discovery of the primary site.

RESULTS

Intraoral metastases comprised 0.03% of all accessioned cases; 22 (55%) occurred in men and 18 (45%) in women (median age = 66.5; range = 18-94 years). Eighteen cases (45%) involved the gingiva, 16 (40%) the gingiva and jawbones, 5 (12.5%) were exclusively intraosseous, and 1 affected (2.5%) the tongue. The lung was the two most frequent primary site in both men (n = 6, 27.3%) and women (n = 5, 27.7%), followed by the colon (n = 4, 18.2%) and kidney (n = 3, 13.7%) in men, and colon (n = 4, 22.2%) and breast (n = 3, 16.6%) in women. Analysis of 1,084 metastatic cases from the literature (male-to-female ratio = 1.2; mean = 52.3; range = 0.6-90 years) indicated strong preference for the jawbones (69.5%) and significant site-specific predilection of certain primary malignancies.

CONCLUSIONS

Oral and gnathic metastases are rare but demonstrate a clear predilection for the gingiva and mandible. Clinicians should remain cognizant of such lesions since they frequently mimic inflammatory, reactive or benign neoplastic processes and, in certain cases, are the first indication of occult disease.

Incidence rate of metastases in the oral cavity: a review of all metastatic lesions in the oral cavity

Background

Metastases in the oral cavity are rare and account for only 1 to 3% of all malignant lesions in this area. The primary location from which most metastases have been described in the oral cavity in adult patients include lungs, breasts, kidneys and colon.

Material and Methods

A systematic search of the literature was carried out following the PRISMA statement in PubMed database. Clinical trials and case series published in the last 10 years [2010-2020] were eligible to be selected. The headings and keywords used in the searches were “cancer” AND “oral metastases”, “incidence” AND “oral metastases”, “oral metastases” AND “jaw bone”, “oral metastases” AND “soft tissue”.

Results

For the study of the incidence of metastases in the oral cavity, 9 reports of clinical trials and 7 retrospective studies of case series have been included in this article. The primary locations from which more metastases have been described in the oral cavity are lungs (30.6% or 183 cases), breasts (22.2% or 133 cases), liver (15.5% or 93 cases), prostate (9 % or 54 cases), thyroid glands (8.1% or 49 cases), kidneys (7.3% or 44 cases), skin (2.3% or 14 cases), soft tissues (2% or 12 cases), colon (2% or 12 cases) and gastrointestinal (0.6% or 4 cases). These metastases have a predilection for hard tissues. The clinical presentation of these lesions varies from painless granulomatous lesions to lytic areas in the jaws.

Conclusions

Although metastases in the oral cavity is an uncommon pathology, early diagnosis is needed so that in the event that it is the first manifestation, it allows the primary tumor to be diagnosed as soon as possible.

Key words:Cancer, oral metastases, incidence, jaw bone, soft tissue.

Gingival exophytic lesions as first oral manifestation of primary lung adenocarcinomas: Systematic review

Metastases from malignant tumors in the oral cavity are rare and comprise approximately 1% of all oral neoplasms, being more frequent in the jaws than in the soft tissues. The presentation of a gingival metastasis as the first manifestation of a primary tumor in the oral cavity is extremely rare. The objective of this review is to update the diagnosis and management of oral metastasis being the first clinical manifestation of the tumor and review all the cases published to date, providing a new original clinical case with very specific histopathological characteristics. We systematically reviewed the literature in order to find all the cases of primary lung tumors that appeared with a gingival metastasis as the first manifestation. The search process involved a total of 1916 articles. After reading the latter, 15 (one of them with two different cases) met the inclusion criteria. Of the 15 articles, 6 were rated as medium quality (40%) and 9 as high quality (60%). We present a lung adenocarcinoma that first manifested as a metastasis in the gum, simulating a benign lesion. The unusually high growth rate of this lesion should conduct to have other diagnostic possibilities, and histopathological confirmation is essential.

Gastrointestinal stromal tumor with maxillary metastasis: a case report and literature review

Gastrointestinal stromal tumors (GISTs) form commonly in the stomach, small intestine, colorectum, and esophagus. Metastatic GIST occurs in up to 50% of patients at presentation. The liver and peritoneal cavity are the most common (93%) metastatic sites; head and neck metastases are extremely rare. This report describes a unique case of a 77-year-old man who was diagnosed with a duodenal GIST that had been completely resected 15 years ago. Eleven years after complete resection, he presented with liver metastases and then received multiple lines of systemic therapy and ablative radiotherapy. In 2015, he presented to our oral and maxillofacial surgery department with a left exophytic maxillary mass that filled the left maxillary sinus. Incisional biopsy confirmed metastatic GIST. Further evaluation revealed extensive metastases in the patient's liver, lungs, spleen, abdominal wall, and lymph nodes. After adequate staging, the patient's condition was deemed palliative, and he was referred to the radiation oncology department for palliative treatment of the symptomatic maxillary lesion. To our knowledge, this is the first reported case of maxillary metastasis from a duodenal GIST. Inclusion of GIST in the differential diagnosis of jaw tumors in patients with nonoral malignancies is recommended. The literature on oral metastasis of GIST is reviewed and discussed in this case report.

Metastatic tumors in the oral region: a retrospective chart review of clinical characteristics and prognosis

OBJECTIVE

The study aimed to evaluate the clinical characteristics and outcomes of patients with metastatic tumors in the oral region.

STUDY DESIGN

We conducted a retrospective study of 14 patients (11 men and 3 women; median age, 70.5 years) with metastatic tumors in the oral region diagnosed between 2005 and 2018.

RESULTS

The primary tumors were located in the lung (n = 7), kidney (n = 3), renal pelvis (n = 1), thyroid (n = 1), stomach (n = 1), and bladder (n = 1). The most common histologic type of the tumor was adenocarcinoma (n = 6). The metastatic sites were the mandible (n = 7), tongue (n = 4), upper gingiva (n = 2), and maxilla (n = 1). In 6 patients, metastatic tumors were found in the oral region before the primary tumors were detected. The primary tumors were detected by positron emission tomography/computed tomography in 5 patients and by computed tomography alone in one patient. Seven patients received treatment for metastatic tumors in the oral region. The overall 1- and 5-year survival rates were 35.7% and 10.7%, respectively.

CONCLUSIONS

It is important to detect metastatic tumors in the oral region and primary tumors as early as possible. Radical or palliative treatment should be performed if possible, considering the condition of the primary tumor and its metastasis to other organs.

Pancreatic Carcinoma Metastatic to the Gingiva

Metastatic tumors to the oral cavity are uncommon, representing approximately 1% of all cases of oral malignant lesions even when a metastatic disease is present. The 53-year-old female is presented complaining of abdominal pain, weight loss, and a loose stool recurring not more than three times per day. A computed tomography (CT) scan of the abdomen showed a retroperitoneal mass expanding along the body of the pancreas. Colonoscopy and gastroscopy with a gastric mucosa biopsy showed a normal result. After laparoscopic surgery, the primary site of adenocarcinoma was not confirmed. The patient was referred to the Maxillofacial Surgery Clinic with pain, swelling, and occasional bleeding around the lower right second mollar. Immunohistochemicaly, the tumor cells were positive for Cytokeratin (CK) 19, Cytokeratin (CK) 7, and homebox protein (CDX-2), which are highly sensitive markers of pancreatobiliar cancer. Therefore, the patient was diagnosed with pancreatic carcinoma. This report describes a rare metastasis of malignant pancreatic tumor to the lower right gingiva and highlights the importance of immunohistochemical examination and how it helped identify both the origin and the nature of gingival neoplasm.

Gingival metastasis of a breast carcinoma

We report a case of metastasis to the gingiva of breast carcinoma. The breast tumor was treated with neoadjuvant chemotherapy followed by a radical mastectomy associated with axillary dissection. The gingival lesion occurred 7 months after surgery; the metastasis was confirmed by a biopsy.

Presentation of cervical metastases and pathological mandibular fracture due to pulmonal adenocarcinoma: A case report

•

Oral metastatic tumors due to malignancies at distant locations are very rare.

•

Cervical metastases of level I and II due to adenocarcinoma of the lung have hardly been described before.

•

Diagnosis of unclear oral lesions requires extensive staging.

•

In cases of oligometastases in the oral region tumor resection may be a curative treatment.

Introduction

Oral metastatic tumors due to malignancies at distant locations are very rare. There are only few cases in the literature reporting about mandible/cervical metastases. Sometimes the oral finding is the manifestation of the disease.

Presentation of case

We report on a 50-year-old patient who was diagnosed with a pathological mandibular fracture and cervical lymph node metastases due to an adenocarcinoma of the lung without other peripheral metastases. Following the interdisciplinary tumor board decision, resection and ipsilateral neck dissection including a mandible reconstruction using a microvascular fibula transplant was performed. The patient received an adjuvant chemotherapy with carboplatin/pemetrexed.

Discussion

The combination of cervical metastases and a pathological mandibular fracture has not been reported before. Distinction between oligometastatic and polymetastatic disease may be difficult. Bone lesions and a high number of metastases are associated with a negative outcome. In cases of limited oligometastatic diseases, metastasectomy might sometimes be indicated. Due to the absence of other peripheral metastases decision of metastasectomy was made.

Conclusion

Due to rare occurrence of cervical metastases special attention should be paid to the incidence of possible metastases of distant malignancies at uncommon regions.

A multicenter study of oral sarcomas in Brazil

OBJECTIVES

The aim of this study was to investigate the prevalence of oral sarcomas from geographic regions of Brazil.

MATERIALS AND METHODS

A cross-sectional study was conducted on biopsies obtained from January 2007 to December 2016 at twelve Brazilian oral and maxillofacial pathology centres. Gender, age, evolution time, clinical aspects, tumour location, tumour size at diagnosis, radiographic aspects and histopathological diagnosis were evaluated. Data were analysed using descriptive statistical methods.

RESULTS

From 176,537, a total of 200 (0.11%) oral sarcomas were reported, and the most prevalent were osteosarcomas (74 cases; 37%) and Kaposi's sarcomas (52 cases; 26%). Males were more affected than females at a mean age of 32.2 years old (range of 3-87 years). The most common symptoms were swelling¸ localised pain and bleeding at a mean evolution time of 5.14 months (range <1-156 months). The lesions were mostly observed in the mandible (90 cases; 45%), with a mean tumour size of 3.4 cm (range of 0.3-15 cm). Radiographically, the lesions presented a radiolucent aspect showing cortical bone destruction and ill-defined limits.

CONCLUSIONS

Oral sarcomas are rare lesions with more than 50 described subtypes. Osteosarcomas and Kaposi's sarcomas were the main sarcomas of the oral cavity in Brazil.

Oral and maxillofacial metastasis of male breast cancer: Report of a rare case and literature review

Oral and maxillofacial metastatic tumors are uncommon, with the breast, prostate, lung, and kidney representing the most common primary sites. Less than 1% of all breast cancers occur in male patients, and to date, only 8 cases of metastatic breast adenocarcinoma to the oral and maxillofacial region in a male patient have been reported in the literature. An 88-year-old male with previous history of a successfully treated primary breast adenocarcinoma 12 years earlier was referred for evaluation of an oral swelling lasting 6 months. Intraoral examination revealed a 2-cm reddish, pedunculated nodule with a smooth surface located in the left retromolar region. Imaging revealed maxillary sinus involvement. The patient underwent incisional biopsy, and microscopic evaluation revealed invasive tumor islands compounded by malignant epithelial cells, sometimes exhibiting ductal arrangement, which were positive for the estrogen receptor and gross cystic disease fluid protein 15. The final diagnosis was metastatic breast adenocarcinoma. Breast metastases are exceedingly rare in the oral and maxillofacial region of male patients; however, clinicians should consider breast metastasis when evaluating reddish oral nodules in older patients, including men, especially those with a history of malignancy.

Epulis-Like Presentation of Gingival Renal Cancer Metastasis

Mouth metastatic cancers are very rare and they usually represent the evidence of a widespread disease. Common primary tumors are lung carcinoma in men and breast carcinoma in women, followed by kidney cancer. In the oral soft tissues, the gingiva is the most common site, suggesting a possible role of inflammation in the attraction of circulating tumor cells. Oral metastasis has a serious prognosis. In this work, we describe the case of a 58-year-old man affected by renal cancer, who was brought to our attention for the appearance of a gingival swelling. Initially, the lesion was excised through a provisional clinical diagnosis of epulis. Subsequently, anatomopathological analysis showed a metastasis compatible with clear-cell carcinoma and specifically its renal origin was confirmed by immunohistochemical techniques.

Mandible metastasis of small cell lung cancer mimicking a residual cyst

Small cell lung carcinoma (SCLC) is an uncommon tumor characterized by an aggressive behavior with early metastasis, usually to the contralateral lung, liver, brain, and bones. There are only five cases of this particular tumor metastasizing to the oral cavity described in the English literature. We present the case of metastatic SCLC in the mandible with radiographic findings resembling a residual cyst. A 66-year-old man with previous diagnosis and treatment for a SCLC was referred to the Stomatology Department with a history of persistent pain in the mandible 1 year after the inferior right pre-molar tooth extraction. The radiographic exam showed a well-delimited radiolucent area on that extracted tooth’s region resembling a residual cyst. Biopsy was performed yielding the diagnosis of metastatic SCLC. The patient was referred to the clinical oncologist for chemotherapy. Although uncommon, this tumor should be included in the differential diagnosis of jawbone lesions, particularly when the patient presents a previous diagnosis of SCLC.

Metastasis to the Jawbones: A review of 453 cases

The purpose of the present article was to review the characteristics of the jawbone metastases to analyze all variables. A relevant English Literature search in PubMed, Scopus, and Google Scholar was performed. All variables such as age, gender, primary and secondary tumor sites were analyzed. There were 453 metastatic cases. The male-to-female ratio was 1.2:1, and the mean age of the patients was 53.4 years. The lung was the most common primary site in men, and breast in women. The most common metastatic site was the mandible, and adenocarcinoma was the most frequent histological diagnosis. Metastases to the jaw bones occur in the advanced stages of a malignancy hence; a careful examination of patients with jaw bone lesions is strongly suggested. Dentists, as well as general physicians, should take into consideration the possible presence of jaw metastases in cases which present atypical symptoms, especially in patients with known malignant disease.

Gingival Metastasis: A Case Report and Literature Review

Secondary oral cavity neoplasms are rare. We describe a case of an indurated, nonulcerating gingival lesion in a 59-year-old nonsmoking man with no family history of lung cancer. The lesion was the presenting symptom of metastatic lung adenocarcinoma. Reviewing the literature, we find that primary lung cancer among men is one of the most common cancers to metastasize to the oral cavity. Renal and cutaneous neoplasms are the next most common neoplasms to metastasize to the oral cavity. Furthermore, the gingiva, a tissue prone to inflammation, is noted to be a common site for secondary oral cavity neoplasms. This rare case highlights that metastases should influence the clinician's differential of oral mucosal lesions.

Metastasis to the oral soft tissues: A review of 412 cases

The present review article analyzes the characteristics of metastases to the oral soft tissues from 1937 to 2015. An extensive literature search was performed. All variables such as age, gender, and primary and secondary tumor sites were analyzed. Metastases to the major salivary glands were not included in this review. In general, there were 412 metastatic lesions developed in the oral soft tissues. The male-to-female ratio was approximately 1.8:1. The mean age of the patients at diagnosis was 58. The lung was the most common primary site and the gingiva was the most common metastatic site. The greater part of the histological examination yielded adenocarcinoma. The diagnosis of a metastatic lesion in the oral cavity is a challenge to the clinicians due to the lack of pathognomonic signs and symptoms. Oral metastases usually occur in the advanced stages of cancers, and the interval between appearance and death is usually short. The oral soft tissue metastasis can be easily recognized compared to the metastasis of jawbones. Early detection of oral lesions is important in the case of being the first sign of a malignancy in other parts of body.

Metastatic Tumours to the Oral Cavity: Report of Three Cases

Background

Metastatic tumours to the oral cavity from distant organs are uncommon and represent approximately 1 - 3% of all oral malignancies. Such metastases can occur to the bone or to the oral soft tissues. Almost any malignancy from any site is capable of metastasis to the oral cavity and a wide variety of tumours have been reported to spread to the mouth.

Methods

Careful examination of the oral cavity and a high degree of clinical suspicion as well as a multidisciplinary approach are suggested.

Results

In this article we present three patients, a female and two males with metastatic tumours to the oral cavity, who were referred to our Department. The primary tumours were invasive lobular breast carcinoma, gastric adenocarcinoma and small cell lung carcinoma respectively.

Conclusions

Metastases to the oral cavity are quite uncommon among population. They usually present with symptoms similar to odontogenic infections and benign tumours, causing a delayed diagnosis and treatment.

Mandibular metastasis in a patient with undiscovered synchronous thyroid and prostate cancer: A diagnostic dilemma

Background:

Mandibular metastasis as the first manifestation of undiscovered synchronous double primary cancers is extremely rare, so, it is presented in the current study.

Case History:

This study reports a 73-year-old man, complaining of a painful mass in the mandible. After history taking, physical examination and panoramic radiographic evaluation; an incisional biopsy was performed intraorally. Histological studies revealed a metastatic tumor of epithelial origin with nonspecific primary site. During metastatic workup of the patient, it was accidentally found that three organs including prostate, lung and thyroid were involved with cancer. Using immunohistochemical study (prostate-specific antigen (PSA), thyroid transcription factor 1 (TTF-1) and thyroglobulin), a final diagnosis of thyroid carcinoma metastasis to the mandible was established.

Discussion:

This case report showed that the practitioners should always maintain a high index of suspicion to the possibility that a patient with an orofacial metastatic lesion may have two or more synchronous primary cancers.

Metastasis of prostate carcinoma in the mandible manifesting as numb chin syndrome

BACKGROUND

Numb chin syndrome is an uncommon but well-recognized symptom in medical oncology. This condition can be related to metastatic neurological manifestation of malignancy, often with no clinically visible pathology. About 1% of oral cancers, which are located in the soft tissues and jaws, are metastases of primary tumors located elsewhere in the body. The posterior mandible is the most common site of metastasis of the oral region because of its rich blood supply in active areas of hematopoiesis. This article describes prostate carcinoma metastasis located in the mandible and temporomandibular joint of a 78-year-old male.

CASE PRESENTATION

A 78-year-old male patient presented to our outpatient clinic with a complaint of numbness and pain on the left site of the mandible. The patient stated that he had been suffering from this numbness for 1 to 2 months. In the medical anamnesis, it was discovered that patient had prostate carcinoma (CA) 5 years previous, and since then, he had visited his doctor periodically for an annual examination. In these examinations and on the basis of tests carried out at the hospital 1 year previous, it was stated that no CA relapse traces were detected. The patient had visited his dentist 2 months previous for pain and numbness of the left molar region.

CONCLUSIONS

We report numb chin syndrome, which is an uncommon neurological manifestation of metastatic malignancy. The clinical course and rapid deterioration after the initial presentation of this syndrome is discussed. This clinical situation illustrates the importance of good medical history review prior to all procedures by the medical professions dealing with oncology patients. An awareness of this condition is crucial, especially in symptoms with unexplained facial pain and numbness.

Non-small cell lung cancer metastasis to the oral cavity: a case report

Lung cancer, including non-small cell lung cancer, remains prevalent in Australia and has a very poor survival rate. Metastases to the oral cavity are a rare occurrence that can arise from lung cancers. This case report describes the presentation of a metastatic lesion from a poorly differentiated lung adenocarcinoma on the mandibular buccal alveolar attached gingivae. The inpatient had terminal disease with known pleural, brain and liver metastases and was receiving palliative care at the time of diagnosis of the oral lesion.

Metastasis of lung adenocarcinoma to the mandible: Report of a case

Adenocarcinoma of the lung that metastasizes to the mandible is uncommon. There are only a few cases described in the English-language literature regarding metastasis to mandible from adenocarcinoma of the lung. This article shows a metastasis from adenocarcinoma of the lung affecting the mandible of a 55-year-old male patient where the metastatic lesion was detected before primary tumor. This article emphasizes the importance of detailed dentoalveolar examination and early diagnosis for finding the primary focus of metastatic lesions.