Upper jaw metastasis as first sign of lung adenocarcinoma
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1
Ospedali Riuniti di Bergamo, Department of Dentistry, Italy
Aim. Metastatic tumours to the oral region are uncommon, comprising only 1-3% of all malignant oral neoplasms. Metastatic lesions may occur in the oral soft tissues, in the jawbones or in both osseous and soft tissues. The common primary sources of tumours metastatic to the oral region are the breast, lung and kidney. Mandible is the most common location for metastases, with the molar area being the most frequently involved site. The Authors describe a case of metastatic adenocarcinoma of the lung diagnosed after a maxillary metastasis was detected.
Materials and Methods. An apparently healthy 77-year-old male patient was admitted to the Department of Dentistry ASST-PG 23 Hospital in June 2018 with three-month history of pain and bleeding from the upper jaw. The patient had an approximately 30-year history of smoking 60 cigarettes daily. The intraoral examination revealed a 3x3 cm ulcerated polypoid exophytic lesion of the left upper jaw. The color of the lesion was red. No other pathologic finding was noticed during the examination. An incisional biopsy of the oral lesion was performed, and the histopathologic findings revealed an adenocarcinoma. The patient was then referred to the Oncology Unit for further evaluation and treatment.
Results. A total body CT scan with contrast and a positron emission tomography (PET) were requested to identify the primitive localization and further potential metastatic lesions. The imaging detected the previously diagnosed left maxillary lesion with associated bony erosion, a large heterogeneous mass in the right lung and multiple osteolytic lesions involving the left fourth rib, the right scapula and the left clavicle. A definitive diagnosis of stage IV pulmonary adenocarcinoma was made, and the patient referred for radiotherapy.
Discussion. Lung carcinomas are biologically aggressive malignancies and are highly prevalent throughout the world. They are characterized by their insidious onset, difficulty in early detection, early metastatic spread and poor prognosis at the time of presentation. Lung carcinomas have some preferential sites for metastasis, such as the brain, bones and adrenal glands. Other organs are usually involved in late stage of the disease. Oral cavity metastasis is usually a manifestation of an advanced stage of primary cancer and indicate widespread and poor diagnosis. This case report emphasizes the crucial importance of a thorough clinical examination for diagnosing metastatic oral lesions.
References
1. Kumar G, Manjunatha B. Metastatic tumors to the jaws and oral cavity. J Oral Maxillofac Pathol. 2013 Jan;17(1):71-5.
2. Gultekin SE, Senguven B, Isik Gonul I, Okur B, Buettner R. Unusual Presentation of an Adenocarcinoma of the Lung Metastasizing to the Mandible, Including Molecular Analysis and a Review of the Literature. J Oral Maxillofac Surg. 2016;74(10):2007.e1-8.
3. Popper HH. Progression and metastasis of lung cancer. Cancer Metastasis Rev. 2016 Mar;35(1):75-91.
Keywords:
Adenocarcinoma,
Lung carcinoma,
Oral metastasis,
Primary cancer,
Upper jaw
Conference:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018.
Presentation Type:
Poster Presentation
Topic:
Oral Diseases
Citation:
Bonacina
R,
Barbaglio
M,
Bardazzi
A,
Martini
V,
Gianatti
A and
Mariani
U
(2019). Upper jaw metastasis as first sign of lung adenocarcinoma.
Front. Physiol.
Conference Abstract:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine..
doi: 10.3389/conf.fphys.2019.27.00010
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Received:
11 Oct 2018;
Published Online:
09 Dec 2019.
*
Correspondence:
Dr. Riccardo Bonacina, Ospedali Riuniti di Bergamo, Department of Dentistry, Bergamo, Lombardy, Italy, marcomascitti86@hotmail.it