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Lung adenocarcinoma presenting as a solitary gingival metastasis: a case report.

Orlandi A, Basso M, Di Salvatore M, Federico F, Cassano A, Barone C - J Med Case Rep (2011)

Bottom Line: 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.However, the tumor proved to be intrinsically resistant and highly aggressive.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy. armando.orlandi@edu.rm.unicatt.it.

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.

No MeSH data available.


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The tumor cells were immunoreactive for thyroid transcription factor 1 (original magnification, × 20).
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Figure 4: The tumor cells were immunoreactive for thyroid transcription factor 1 (original magnification, × 20).

Mentions: An apparently healthy, 74-year-old Caucasian woman who was a non-smoker and had no history of alcohol addiction presented with swelling of the vestibular gingival mucosa at the level of the lower right incisors (Figure 1). No other pathologic finding was noticed during the physical examination. She underwent an excisional biopsy of the lesion, and histopathologic immunohistochemistry showed a poorly differentiated adenocarcinoma expressing cytokeratin 7 and thyroid transcription factor 1, whereas cytokeratins 5, 6 and 20 were absent. The pattern suggested a metastasis of lung cancer (Figures 234). The total-body computed tomographic (CT) scan with contrast-enhancing medium revealed a 7.4 cm-sized tumor of the lower lobe of the right lung with metastases to the ipsilateral mediastinal lymph nodes (cT3N2). No other metastases were detected, and her bone scan was also negative. An orthopantomogram of the dental arches excluded metastases to the jawbones (Figure 5). After multi-disciplinary clinical evaluation, sequential treatment was planned, including neoadjuvant chemotherapy (ChT) followed by concomitant chemoradiation and surgery. Platinum-based combination therapy was selected, but cisplatinum was excluded because the patient had low-grade renal insufficiency with a serum creatinine level of 1.8 mg/dL. Therefore, carboplatin area under the curve 6 on day one and gemcitabine (1000 mg/mq on days one and eight) every three weeks were started. Two months later, after she had undergone three cycles of ChT, her CT scan showed clear expansion of the primary tumor with diffuse infiltration of the right lung. A second-line treatment with docetaxel was attempted, but the tumor rapidly progressed and the patient died six weeks later as a result of respiratory failure.


Lung adenocarcinoma presenting as a solitary gingival metastasis: a case report.

Orlandi A, Basso M, Di Salvatore M, Federico F, Cassano A, Barone C - J Med Case Rep (2011)

The tumor cells were immunoreactive for thyroid transcription factor 1 (original magnification, × 20).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117826&req=5

Figure 4: The tumor cells were immunoreactive for thyroid transcription factor 1 (original magnification, × 20).
Mentions: An apparently healthy, 74-year-old Caucasian woman who was a non-smoker and had no history of alcohol addiction presented with swelling of the vestibular gingival mucosa at the level of the lower right incisors (Figure 1). No other pathologic finding was noticed during the physical examination. She underwent an excisional biopsy of the lesion, and histopathologic immunohistochemistry showed a poorly differentiated adenocarcinoma expressing cytokeratin 7 and thyroid transcription factor 1, whereas cytokeratins 5, 6 and 20 were absent. The pattern suggested a metastasis of lung cancer (Figures 234). The total-body computed tomographic (CT) scan with contrast-enhancing medium revealed a 7.4 cm-sized tumor of the lower lobe of the right lung with metastases to the ipsilateral mediastinal lymph nodes (cT3N2). No other metastases were detected, and her bone scan was also negative. An orthopantomogram of the dental arches excluded metastases to the jawbones (Figure 5). After multi-disciplinary clinical evaluation, sequential treatment was planned, including neoadjuvant chemotherapy (ChT) followed by concomitant chemoradiation and surgery. Platinum-based combination therapy was selected, but cisplatinum was excluded because the patient had low-grade renal insufficiency with a serum creatinine level of 1.8 mg/dL. Therefore, carboplatin area under the curve 6 on day one and gemcitabine (1000 mg/mq on days one and eight) every three weeks were started. Two months later, after she had undergone three cycles of ChT, her CT scan showed clear expansion of the primary tumor with diffuse infiltration of the right lung. A second-line treatment with docetaxel was attempted, but the tumor rapidly progressed and the patient died six weeks later as a result of respiratory failure.

Bottom Line: 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.However, the tumor proved to be intrinsically resistant and highly aggressive.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy. armando.orlandi@edu.rm.unicatt.it.

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.

No MeSH data available.


Related in: MedlinePlus