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Mota ME, Tomo S, Alves FDA, Pellissari GA, do Nascimento AG, Lopes RN. Gingival metastasis of angiosarcoma of the breast as a first manifestation of spreading disease: Case report and review of the literature. SPECIAL CARE IN DENTISTRY 2024; 44:458-464. [PMID: 37341541 DOI: 10.1111/scd.12896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Angiosarcoma is an aggressive malignant neoplasm of vascular origin. Oral metastases of angiosarcoma are rare and have a non-specific clinical presentation, thus the diagnosis may be challenging. CASE REPORT Herein we report a case of a 34-year-old female patient after treatment of a high-grade angiosarcoma of the breast, who presented an asymptomatic bleeding purplish nodule in the maxillary interdental papilla between the first and second premolar. A biopsy was performed, and the histological examination revealed infiltration by malignant neoplasm of epithelioid and fusocellular pattern. Immunohistochemical analysis demonstrated that neoplastic cells were positive for ERG and CD31, and negative for cytokeratins AE1/AE3, confirming the diagnosis of metastatic angiosarcoma. After investigation, multiple metastases were discovered. The patient is under management with chemotherapy and palliative radiotherapy for the bone lesions. CONCLUSION Metastases should be considered in the differential diagnosis of oral lesions in patients with a previous history of cancer. Due to the morphology of angiosarcomas, the metastatic lesions may resemble benign vascular lesions, therefore, biopsy is mandatory to exclude malignancy.
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Affiliation(s)
- Maria Emília Mota
- Department of Stomatology, A.C.Camargo Cancer Center, São Paulo, Brazil
| | - Saygo Tomo
- Department of Stomatology, A.C.Camargo Cancer Center, São Paulo, Brazil
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Aga N, Shreevats R, Gupta S, Sandhu H, Hassan ME, Prajapati HV. Oral Soft Tissue Metastasis from Breast Cancer as the Only Primary Source: Systematic Review. Avicenna J Med 2024; 14:22-38. [PMID: 38694143 PMCID: PMC11057901 DOI: 10.1055/s-0044-1779674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Background Breast cancer is one of the most lethal neoplasms causing death. Oral cavity is the rare site of distant metastasis from breast cancer. Very little research has been conducted to date to analyze breast cancer as the sole primary source of metastasis to the oral soft tissues. The goal of this study was to examine the published cases of oral soft tissue metastasis from breast cancer as the only primary source to date. Methods An electronic search of the published literature was performed without publication year limitation in PubMed/Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like ("Breast cancer", OR "Breast carcinoma") AND ("Metastasis" OR "Metastases"), And ("Oral soft tissues" OR "Tongue" OR "Palate" OR "Tonsil" OR "Buccal mucosa" OR "Floor of mouth" OR "Vestibule" OR "Salivary glands"). We also searched all related journals manually. The reference list of all articles was also checked. Results Our research revealed 88 relevant papers (September 1967-September 2023) with 96 patients in total. The most predominant oral soft tissues involved were salivary glands followed by the gingiva, tonsils, tongue, and buccal mucosa. A total of 23% of patients died with an average survival time of 1 to 15 months. Conclusions Oral soft tissue metastasis from breast cancer is a rare event and has a bad prognosis. More cases need to be published to raise awareness of these lesions.
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Affiliation(s)
- Nausheen Aga
- School of Dentistry, University of Dundee, Dundee, Scotland, United Kingdom
| | - Ruchira Shreevats
- Department of Orthodontics, Primadent Dental Centre, Bangalore, Karnataka, India
| | - Sonia Gupta
- Department of Oral Pathology and Microbiology and Forensic Odontology, Yamuna Institute of Dental Sciences & Research, Gadholi, Yamunanagar, Haryana, India
| | - Harman Sandhu
- General Dentistry, Building Smiles Dental Clinic, Mohali, Punjab, India
| | - Muna E.M. Hassan
- Department of Preventive and Restorative Dentistry, University of Sharjah, United Arab Emirates
| | - Harnisha V. Prajapati
- General Dentistry, Bhavya Dental Clinic and Implant Centre, Palanpur, Gujarat, India
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Chen CC, Lee CT, Chang SL, Tsai MC. A case of palatine tonsillar metastasis of lung adenocarcinoma: A CARE-compliant article. Medicine (Baltimore) 2019; 98:e15763. [PMID: 31145296 PMCID: PMC6709259 DOI: 10.1097/md.0000000000015763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Palatine tonsil is an extremely rare site for metastatic disease, accounting for 0.8% of malignant tonsillar neoplasms. To the best of our knowledge, this is the first report of metastatic adenocarcinoma in the tonsil treated with wide excision and targeted therapy, with no local recurrence 6 months postoperatively. PATIENT CONCERNS A 75-year-old man presented hemoptysis and mild productive cough for 2 weeks. DIAGNOSES Palatine tonsil metastasis from lung adenocarcinoma, pT2bN0M1b, stage IVA, was confirmed. INTERVENTIONS Wide excision of primary lung tumor and metastatic tonsil carcinoma has been performed, and the patient was undergoing targeted therapy with the epidermal growth factor receptor inhibitor afatinib. OUTCOMES There was no local recurrence in the oropharynx 6 months postoperatively. LESSONS We aim at highlighting the importance of a thorough evaluation for suspicion of tonsillar enlargement, which might be a sign of a primary malignancy elsewhere.
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Affiliation(s)
- Chia-Chun Chen
- Department of Otorhinolaryngology, Chi Mei Medical Center
| | - Chin-Tse Lee
- Department of Otorhinolaryngology, Chi Mei Medical Center
| | - Shih-Lun Chang
- Department of Otorhinolaryngology, Chi Mei Medical Center
- Department of Optometry, Chung Hwa University of Medical Technology
| | - Meng-Chen Tsai
- Pathology Center, Chi Mei Medical Center, Tainan, Taiwan
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Irani S. Metastasis to the oral soft tissues: A review of 412 cases. J Int Soc Prev Community Dent 2016; 6:393-401. [PMID: 27891304 PMCID: PMC5109852 DOI: 10.4103/2231-0762.192935] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/22/2016] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Soussan Irani
- Dental Research Center, Department of Oral Pathology, Dental Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
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Chamberland F, Maurina T, Degano-Valmary S, Spicarolen T, Chaigneau L. Angiosarcoma: A Case Report of Gingival Disease with Both Palatine Tonsils Localization. Rare Tumors 2016; 8:5907. [PMID: 27746875 PMCID: PMC5064291 DOI: 10.4081/rt.2016.5907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/28/2016] [Accepted: 05/13/2016] [Indexed: 11/23/2022] Open
Abstract
Angiosarcomas are one of the rarest subtypes of sarcomas; those are malignant vascular tumors arising from vascular endothelial cells. Occurrence of intra-oral angiosarcoma is extremely rare (0.0077% of all cancers in Europe). We present here, to our knowledge, the first case of a 83-year-old man with gingival and both palatine tonsils localization of a grade-two angiosarcoma discovered after a two months history of a painful lesion followed by hematoma and spontaneous bleeding. Chemotherapy with paclitaxel and hemostatic radiotherapy were inefficient and he died seven months after the first symptoms. It is essential to use the vascular markers, such as CD34, CD31, ERG and FLI1, for a correct histological diagnosis, which remains difficult because it displays a wide range of morphological appearances and multiple patterns may be present in the same tumor. The main prognostic factors are chronic pre-existing lymphedema and tumor size greater than five centimeters. Malignancy grade and stage classification should be provided in all cases in which this is feasible because of predictive meaning. When possible, wide surgical resection with negative margins remains the cornerstone for the treatment of localized angiosarcomas, but despite the improvement of surgical techniques the prognosis is poor with more than half of patients died within the first year. Adjuvant radiotherapy is the standard treatment of high–grade (two and three), deep lesions, regardless of size, because it improved the local recurrence-free survival. For advanced disease, if possible, metastasectomy should be considered. The first-line chemotherapy with doxorubicin or paclitaxel should be discussed compared to best supportive care according to patient comorbidities and preference.
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Affiliation(s)
- Frédéric Chamberland
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Nord Franche-Comté , Belfort
| | - Tristan Maurina
- Department of Oncology, University Hospital Center Jean Minjoz , Besançon, France
| | | | - Thierry Spicarolen
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Nord Franche-Comté , Belfort
| | - Loïc Chaigneau
- Department of Oncology, University Hospital Center Jean Minjoz , Besançon, France
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Unsal M, Kutlar G, Sullu Y, Yurtlu S. Tonsillar metastasis of small cell lung carcinoma. CLINICAL RESPIRATORY JOURNAL 2015; 10:681-683. [PMID: 25620524 DOI: 10.1111/crj.12275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 11/23/2014] [Accepted: 01/20/2015] [Indexed: 11/27/2022]
Abstract
Metastasis to palatine tonsils are rare, accounting from only 0.8% of all tonsillar tumors, so far only 100 cases reported in the English literature. Only a few cases have been reported for small cell and non-small cell lung cancer as a primary site. With a diagnosis of small cell lung cancer, a 68-year-old male patient relapsed after six cycles of chemotherapy in tonsilla palatina and cervical lymph nodes. Patients died 26 months after being diagnosed with lung cancer and 2 months after detection of tonsil metastasis. We present the current case report because of the rarity of metastasis to tonsil in lung cancer.
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Affiliation(s)
- Meftun Unsal
- Department of Chest, Faculty of Medicine, Ondokuzmayis University, Samsun, Turkey
| | - Gokhan Kutlar
- Department of Otolaryngology, Faculty of Medicine, Ondokuzmayis University, Samsun, Turkey.
| | - Yurdanur Sullu
- Department of Pathology, Faculty of Medicine, Ondokuzmayis University, Samsun, Turkey
| | - Sirin Yurtlu
- Department of Chest, Sinop State Hospital, Sinop, Turkey
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Arora TK, Terracina KP, Soong J, Idowu MO, Takabe K. Primary and secondary angiosarcoma of the breast. Gland Surg 2014; 3:28-34. [PMID: 25083491 DOI: 10.3978/j.issn.2227-684x.2013.12.03] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/19/2013] [Indexed: 01/31/2023]
Abstract
Angiosarcoma is a rare soft tissue tumor of the breast. It occurs in both a primary form without a known precursor, and a secondary form that has been associated to a history of irradiated breast tissue. These forms differ in many ways including median age, precipitating factors, and presentation. Both forms have a malignant behavior and a poor prognosis. The endeavor of this paper is to review what is known about the presentation, diagnostic and therapeutic modalities to date.
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Affiliation(s)
- Tania K Arora
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - Krista P Terracina
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - John Soong
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - Michael O Idowu
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - Kazuaki Takabe
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
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Sano R, Sato E, Watanabe T, Oshima H, Ando A, Masaki M, Nakashima T. Phyllodes tumor metastasis to the tonsil with synchronous undifferentiated carcinoma. Int J Surg Case Rep 2014; 5:290-3. [PMID: 24747756 PMCID: PMC4066566 DOI: 10.1016/j.ijscr.2014.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/05/2014] [Accepted: 03/16/2014] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Breast tumor metastasis to the tonsil is extremely rare. PRESENTATION OF CASE A 54-year-old woman underwent resection of a breast malignant phyllodes tumor and later presented with metastasis to the lung and the left tonsil. She underwent left lower lobectomy and resection of the left tonsillar tumor. She subsequently developed undifferentiated carcinoma of the right tonsil. She underwent resection of the right tonsillar tumor and chemotherapy was started. The central venous catheter became infected with methicillin-resistant Staphylococcus aureus. Finally, she died. DISCUSSION To the best of our knowledge, this is the first reported case of a phyllodes tumor metastasizing to the tonsil. Furthermore, morphological and immunohistochemical study revealed that the right tonsillar tumor was irrelevant to the phyllodes tumors. CONCLUSION We report a case of phyllodes tumor metastasis to the left tonsil which developed undifferentiated carcinoma in the other side of tonsil later. Breast tumor metastasis to the tonsil is rare but it should be considered as a possible diagnosis.
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Affiliation(s)
- Rui Sano
- Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya University, Nagoya, Japan; Department of Otorhinolaryngology, Japan Labor Health and Welfare, Chubu Rosai Hospital, Nagoya, Japan.
| | - Eisuke Sato
- Department of Otorhinolaryngology, Japan Labor Health and Welfare, Chubu Rosai Hospital, Nagoya, Japan
| | | | - Hisakazu Oshima
- Department of Otorhinolaryngology, Chita City Hospital, Chita, Japan
| | - Atsushi Ando
- Department of Otorhinolaryngology, Japan Labor Health and Welfare, Chubu Rosai Hospital, Nagoya, Japan
| | - Michihiro Masaki
- Department of Otorhinolaryngology, Japan Labor Health and Welfare, Chubu Rosai Hospital, Nagoya, Japan
| | - Tsutomu Nakashima
- Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Chen XH, Bao YY, Zhou SH, Wang QY, Zhao K. Palatine Tonsillar Metastasis of Small-Cell Neuroendocrine Carcinoma from the Lung Detected by FDG-PET/CT After Tonsillectomy: A Case Report. IRANIAN JOURNAL OF RADIOLOGY 2013; 10:148-51. [PMID: 24348600 PMCID: PMC3857977 DOI: 10.5812/iranjradiol.9281] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/20/2013] [Accepted: 04/08/2013] [Indexed: 11/16/2022]
Abstract
Metastasis from a malignant tumor to the palatine tonsils is rare, accounting for only 0.8% of all tonsillar tumors, with only 100 cases reported in the English-language literature. Various malignant lung carcinomas may metastasize to the tonsils. A few cases of tonsillar metastasis from neuroendocrine lung carcinoma have been reported. A 67-year-old female underwent a right tonsillectomy because of a sore throat and an enlarged right tonsil. The postoperative pathology showed right tonsillar small cell neuroendocrine carcinoma (SCNC). Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) demonstrated metabolic activity in the lower lobe of the right lung. In addition, hypermetabolic foci were noted in the lymph nodes of the right neck and mediastinum. A needle biopsy of the pulmonary mass showed SCNC. The patient received chemotherapy and died of multiple distant metastases after 6 months. This is the first report using PET/CT to evaluate tonsillar metastasis from lung SCNC.
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Affiliation(s)
- Xiao-Hong Chen
- Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Otolaryngology, the Second Hospital of Jiaxing City 314000, Zhejiang, China
| | - Yang-Yang Bao
- Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shui-Hong Zhou
- Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Corresponding author: Shui-Hong Zhou, Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. Tel.: +86-13868060120, Fax: +86-57187236895, E-mail:
| | - Qin-Ying Wang
- Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kui Zhao
- Center of PET, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Agaimy A, Kirsche H, Semrau S, Iro H, Hartmann A. Cytokeratin-positive epithelioid angiosarcoma presenting in the tonsil: a diagnostic challenge. Hum Pathol 2012; 43:1142-7. [PMID: 22406364 DOI: 10.1016/j.humpath.2011.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 10/20/2011] [Accepted: 10/24/2011] [Indexed: 12/15/2022]
Abstract
Primary oral cavity sarcomas are exceedingly rare and may pose a great diagnostic challenge. A 71-year-old woman without history of malignancy or radiation to the head and neck presented with an antibiotic-refractory diffuse painful swelling of the right tonsil necessitating tonsillectomy. Histologic evaluation revealed subtotal replacement of the right tonsil by a high-grade epithelioid neoplasm displaying extensive ulceration, necrosis, and primitive vasoformation. Immunohistochemistry showed strong/diffuse expression of pancytokeratin antibodies KL-1 and Lu5, cytokeratin 8, cytokeratin 18, cytokeratin 19, vimentin, CD31, ERG, and Freund leukemia integration site 1 (FLI-1). High-molecular-weight cytokeratins (cytokeratin 5, 34β12), cytokeratin 7, cytokeratin 13, and cytokeratin 20 were not expressed. Within months, the patient underwent surgical resection of multiple bleeding intraoral and gastrointestinal metastases. She is currently alive with disease 9 months from diagnosis. To our knowledge, this case represents the first well-documented primary epithelioid angiosarcoma of the tonsil. The strong cytokeratin expression in epithelioid angiosarcomas represents a diagnostic pitfall. Thus, awareness of this rare and highly aggressive neoplasm is necessary for distinguishing it from poorly differentiated and acantholytic squamous cell carcinoma and diffuse large cell lymphoma.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, University Hospital, 91054 Erlangen, Germany.
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