Suppl.completo reimpag._4b_. 04/10/13 15:55 Pagina 21
Case Report
Unusual solid tumors metastasis to the oral cavity M. Gobbo, G. Ottaviani, K. Rupel, R. Di Lenarda, M. Biasotto Division of Oral Medicine and Pathology, University of Trieste, Ospedale Maggiore, Italy
Metastatic tumors to the oral cavity account for less than 1.5% of malignant oral neoplasms. They usually occur in patients aged 40-70 years both as bone and soft tissues’ lesions, above all in the lower molar area. Metastatic tumors usually derive from lung, breast, kidney, bone, colorectal and thyroid cancer. Diagnosing a metastatic lesion in the oral cavity is challenging although of great clinical significance since it can be the first manifestation of an unknown neoplasia. We present two case reports of metastasis from solid tumors to the oral cavity. A 66-year-old male patient, complained about chewing pain in February 2013. He had been operated for prostate (2010), lung (2011) and thyroid cancer (2012). Tumor and swelling in the lower right alveolar ridge and omolateral lymphoadenopathy were found. X-rays revealed a wide osteolytic area in the lower right mandible as well as smaller spread ones controlaterally. Bone biopsy was taken on the right side and revealed metastatic follicular thyroid cancer whereas contralateral lesions were free of disease. Hemimandibulectomy and reconstruction through microvascular fibula flap were performed. Neither mucosal/bone lesions nor symptoms were evidenced after 5-month reevaluation. A 69-year-old patient was referred to the EDU for oral pain of unknown origin, non-responsive to 2-week amoxicillin and NSAIDs therapy. Intraoral examination revealed tooth 1.7 mobility and fistula. After tooth extraction and continuation of medical therapy, no amelioration was obtained. The patient was referred to the Oral Medicine and Pathology Department. Swelling, redness and purulent exudate coming from a large, exophytic and thick mass located in the post-extractive site were present. Immediately, a mucosa and bone biopsy was taken. Pathologist’s report revealed metastasis from colon cancer. Afterwards, patient was diagnosed with advanced pleomorphic indifferentiated colon adenocarcinoma. He died one month after palliative hemicolectomy. References • • •
Kumar G, Manjunatha B. Metastatic tumors to the jaws and oral cavity; J Oral Maxillofac Pathol 2013 Jan;17(1). Kim DW, Hah JH, An SY, Chang H, Kim KH. Follicular thyroid carcinoma presenting as bilateral cheek masses. Clin Exp Otorhinolaryngol 2013 Mar; 6(1):52-5. Soares AB, Thomaz LA, Duarte MT, de Camargo de Moraes P, de Araújo VC. Metastatic adenocarcinoma of the colon: early manifestation in gingival tissue. Head Neck Pathol 2011 Jun; 5(2):140-3.
Annali di Stomatologia 2013; Suppl. 2: 1-48
21
Case Report
Unusual solid tumors metastasis to the oral cavity M. Gobbo, G. Ottaviani, K. Rupel, R. Di Lenarda, M. Biasotto Division of Oral Medicine and Pathology, University of Trieste, Ospedale Maggiore, Italy
Metastatic tumors to the oral cavity account for less than 1.5% of malignant oral neoplasms. They usually occur in patients aged 40-70 years both as bone and soft tissues’ lesions, above all in the lower molar area. Metastatic tumors usually derive from lung, breast, kidney, bone, colorectal and thyroid cancer. Diagnosing a metastatic lesion in the oral cavity is challenging although of great clinical significance since it can be the first manifestation of an unknown neoplasia. We present two case reports of metastasis from solid tumors to the oral cavity. A 66-year-old male patient, complained about chewing pain in February 2013. He had been operated for prostate (2010), lung (2011) and thyroid cancer (2012). Tumor and swelling in the lower right alveolar ridge and omolateral lymphoadenopathy were found. X-rays revealed a wide osteolytic area in the lower right mandible as well as smaller spread ones controlaterally. Bone biopsy was taken on the right side and revealed metastatic follicular thyroid cancer whereas contralateral lesions were free of disease. Hemimandibulectomy and reconstruction through microvascular fibula flap were performed. Neither mucosal/bone lesions nor symptoms were evidenced after 5-month reevaluation. A 69-year-old patient was referred to the EDU for oral pain of unknown origin, non-responsive to 2-week amoxicillin and NSAIDs therapy. Intraoral examination revealed tooth 1.7 mobility and fistula. After tooth extraction and continuation of medical therapy, no amelioration was obtained. The patient was referred to the Oral Medicine and Pathology Department. Swelling, redness and purulent exudate coming from a large, exophytic and thick mass located in the post-extractive site were present. Immediately, a mucosa and bone biopsy was taken. Pathologist’s report revealed metastasis from colon cancer. Afterwards, patient was diagnosed with advanced pleomorphic indifferentiated colon adenocarcinoma. He died one month after palliative hemicolectomy. References • • •
Kumar G, Manjunatha B. Metastatic tumors to the jaws and oral cavity; J Oral Maxillofac Pathol 2013 Jan;17(1). Kim DW, Hah JH, An SY, Chang H, Kim KH. Follicular thyroid carcinoma presenting as bilateral cheek masses. Clin Exp Otorhinolaryngol 2013 Mar; 6(1):52-5. Soares AB, Thomaz LA, Duarte MT, de Camargo de Moraes P, de Araújo VC. Metastatic adenocarcinoma of the colon: early manifestation in gingival tissue. Head Neck Pathol 2011 Jun; 5(2):140-3.
Annali di Stomatologia 2013; Suppl. 2: 1-48
21
