Báo cáo y học: Lung adenocarcinoma presenting as a solitary gingival metastasis: a case report

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Báo cáo y học: "Lung adenocarcinoma presenting as a solitary gingival metastasis: a case report"Orlandi et al. Journal of Medical Case Reports 2011, 5:202 JOURNAL OF MEDICALhttp://www.jmedicalcasereports.com/content/5/1/202 CASE REPORTS CASE REPORT Open AccessLung adenocarcinoma presenting as a solitarygingival metastasis: a case reportArmando Orlandi1*, Michele Basso1, Mariantonietta Di Salvatore1, Francesco Federico2, Alessandra Cassano1 andCarlo Barone1 Abstract Introduction: Gingival metastases are very rare and generally occur in disseminated tumors. We report a case of solitary gingival metastasis of lung cancer. Case presentation: We report the case of a 74-year-old asymptomatic Caucasian woman affected by a rapidly growing, painless gingival swelling. Histopathologic examination of the excisional biopsy showed metastasis of poorly differentiated thyroid transcription factor 1-positive adenocarcinoma. A total-body computed tomographic scan revealed a tumor of the right lung lower lobe with ipsilateral, mediastinal lymph node swelling. Moreover, bone scintigraphy revealed no bone metastases. No other metastases were found, so we planned a multi-modal therapeutic approach with a curative intent. However, the tumor proved to be intrinsically resistant and highly aggressive. Conclusion: The presentation of solitary gingival metastasis is exceptional. In view of its rapid clinical evolution, our case confirms that gingival metastasis is an important prognostic factor. This behavior raises the question whether the poor prognosis for patients with tumors with oral metastases depends on its diffuse spread or on its highly malignant nature.Introduction weeks to less than six months, with five-year survival lower than 5% [7-10]. The poor prognosis related to thisOral metastatic tumors are rare, comprising approxi- condition points out the importance of differentiatingmately 1% of all oral tumors [1]. The jawbones are oral metastases from benign lesions, which often isaffected in 90% of the cases, whereas metastases to the achievable only by surgical excision. The case that wesoft tissues of the oral cavity occur very rarely and report here shows that a gingival metastasis may be themostly involve the gingiva (54% of soft tissue metas- only presenting sign of lung adenocarcinoma, but ittases), followed by the alveolar mucosa or the tongue remains associated with a dismal outcome.[2,3]. Metastases may reach the oral cavity hematogen-ously, mainly through inversion of the venous flow inthe cervical Batson’s plexus [4]. Alternatively, exfoliating Case presentationcancer cells might be implanted in the oral mucosa by An apparently healthy, 74-year-old Caucasian woman whoretrograde spreading along the respiratory tract or by was a non-smoker and had no history of alcohol addictioncough [5]. The hyper-vascularization in inflamed period- presented with swelling of the vestibular gingival mucosaontal tissues may be a causative factor [6]. In 30% of at the level of the lower right incisors (Figure 1). No othercases, oral metastasis is the first manifestation of cancer, pathologic finding was noticed during the physical exami-but it is often a sign of advanced disease with nation. She underwent an excisional biopsy of the lesion,multi-metastatic involvement [7]. In fact, survival after and histopathologic immunohistochemistry showed arecognition of gingival metastasis ranges from a few poorly differentiated adenocarcinoma expressing cytokera- ...