How Would You Know if Your Oral Cancer Spread to Your Lungs
Mol Clin Oncol. 2017 Mar; 6(3): 422–424.
Not-small-jail cell lung cancer metastasis to the oral crenel: A case study
Hiroyuki Ito
1Division of Oral and Maxillofacial Surgery, Mito Medical Center, Academy of Tsukuba, Mito, Ibaraki 310-0015, Japan
Kojiro Onizawa
1Division of Oral and Maxillofacial Surgery, Mito Medical Heart, Academy of Tsukuba, Mito, Ibaraki 310-0015, Japan
Hiroaki Satoh
twoPartition of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Nihon
Received 2016 April nineteen; Accustomed 2016 May thirty.
Abstract
We herein report an unusual occurrence of lung cancer metastasis to the oral crenel, reflecting the progression of the primary malignancy. A biopsy of oral lesions should always be performed, even of those located in uncommon sites, in patients with a history of uncontrolled lung cancer. Although this is a rare occurrence, our patient exhibited characteristics suggestive of oral metastasis from lung cancer, namely presence of lung adenocarcinoma, development of oral metastasis during the clinical course of the disease, accompanying multiple metastatic lesions, including to the encephalon and abdomen, and rapid fatal progression later on the manifestation of oral metastasis. It is important to admit the possibility of metastasis to the oral crenel in lung cancer patients with extensive metastases. Prompt diagnosis by biopsy of the lesion is required to institute the correct diagnosis.
Keywords: metastasis, lung adenocarcinoma, oral cavity
Introduction
Metastasis to the oral cavity is a rare upshot in cancer patients. This distant spread indicates that cancer cells may reach several sites throughout the torso via the bloodstream and the lymphatic system (1,2). Similar to other malignant diseases, oral metastasis from lung cancer reflects the progression of the primary malignancy, and the majority of such patients present with multiple metastatic sites (iii,iv). Recently, however, some researchers reported patients with no metastasis other than to the oral cavity (5–seven). The clinical presentation of oral metastasis may vary from local swelling or pain to paresthesia (two). Oral metastatic lesions are divided into bone (mandible and maxilla) and mucosal metastases (1). Notwithstanding, as in the majority of the cases both the bone and the mucosa are affected, the first metastatic site may not ever exist apparent. We herein report a case with oral metastasis from lung adenocarcinoma and review previously reported cases of lung cancer patients with oral metastasis.
Case report
An 85-year-old homo presented with a right-sided buccal tumor. One twelvemonth prior, the patient had been diagnosed with primary lung adenocarcinoma. As the performance status was poor, the patient only received supportive intendance. The cocky-reported history of the buccal lesion was rapid growth of the mass over a 2-week period with associated bleeding and pain. The patient was referred to the Oral and Maxillofacial Surgery Unit of the Mito Medical Middle (Mito, Japan) for investigation and management. Concrete examination revealed a marked swelling on the left upper buccal gingiva (Fig. 1). T2-weighted magnetic resonance imaging also revealed a marked swelling on the left upper buccal gingiva (Fig. 2). A biopsy specimen of the lesion obtained under local anesthesia without complications was sent for histopathological examination. The histopathology of the specimen was morphologically consistent with adenocarcinoma and immunohistochemical staining was positive for cytokeratin-7 and thyroid transcription factor-one, which supported the diagnosis of metastasis to the oral crenel from lung adenocarcinoma. Brain magnetic resonance imaging and chest and intestinal computed tomography scans revealed metastatic lesions in the brain, pancreas, adrenal glands and kidneys. The oral lesion was irradiated, but the response was poor and the patient shortly succumbed due to cachexia. Informed consent was obtained from the patient'southward family for the publication of the case details.
Physical test revealed a marked swelling on the left upper buccal gingiva.
T2-weighted magnetic resonance imaging showing a mass located in the left upper buccal gingiva.
Discussion
Metastasis to the oral crenel is rare and represents ~i–ii% of all oral malignancies (1,eight). Due to its rarity and lack of specific gross characteristics, oral metastasis may be mistakenly diagnosed every bit a benign primary oral disease at the time of detection. Some researchers reported that the most frequent malignancies metastasizing to the oral cavity are lung, chest, kidney, prostate, thyroid, and stomach cancers (8–10), whereas others describe lung cancer as the most common malignancy metastasizing to the oral cavity, followed by breast, kidney and liver cancers (xi,12). Metastasis to the oral cavity may occur at any age, only is nigh mutual during the fifth and sixth decades of life (viii). Hischberg et al reported that 70% of oral metastases manifested after the primary tumor became evident, while the remaining 30% were the first clinical manifestation of master tumor spread (13). The patient in the present case was elderly and the oral metastasis was identified 1 year after the primary lung cancer was diagnosed.
A rapidly progressing lesion accompanied by pain and paresthesia are the most mutual symptoms, whereas a bony swelling with tenderness over the affected area is observed in several cases (14). Our patient complained of a non-healing mass on the surface of his left upper buccal gingiva. The lesion was first considered to exist a principal oral disease; however, excisional biopsy revealed lung adenocarcinoma.
Of note, the majority of oral metastases are located in the mandible, with a maxillary location being less common. Possible routes of metastasis to the mouth include the bloodstream and the lymphatic system. It is generally accepted that the mandible and the maxilla do not comprise lymphatic vessels; therefore, the but practical route for metastasis to the mandible is the blood vessels (15). Metastatic foci in the bones are mainly situated in the red marrow (16); notwithstanding, the mandible in adults contains carmine marrow mainly in the surface area of the ascending ramus and in the angles, whereas the maxilla just contains fatty marrow. This may explain the predilection of the mandible to afar metastases, also equally the preferred localization in the maxilla (17). Withal, direct buccal or gingival metastases from lung cancer, to sites other than the maxilla and mandible, have been reported (1). In our case, as oral metastasis extended from the left upper buccal gingiva to the left maxilla, the first metastatic site was not apparent.
The occurrence of metastasis to the oral crenel is generally a sign of extensive metastases, indicating a fatal issue before long after the diagnosis of oral metastasis (ten,13). Our patient had extensive metastases when the oral lesion was identified. This distant spread indicates that cancer cells may reach numerous sites in the entire body via the bloodstream and the lymphatic arrangement. Of note, as observed in our patient, the majority of patients with rima oris metastasis from a main cancer share 4 characteristics: i) Lung adenocarcinoma, ii) development of oral metastasis during the clinical form of the disease, iii) accompanying multiple metastatic lesions, including to the brain and abdomen, and iv) rapid fatal progression later the manifestation of oral metastasis (3,v,seven,18–twenty).
When a new oral lesion is identified, either past the physician or the patient, in patients who have a history of uncontrolled lung cancer, a biopsy of the lesion should exist performed, fifty-fifty in cases with an uncommon location. It is of import to acknowledge the possibility that metastasis to the oral cavity may occur in lung cancer patients with extensive metastases. Prompt diagnosis may lead to beneficial treatment in certain patients, particularly those harboring epidermal growth factor receptor mutations (21,22), and an improved quality of life. However, adequative palliative intendance to better the quality of life and prolong survival is the main goal for patients with metastasis to the rima oris, until more efficient treatments are developed.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403262/
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