A testicular tumor with gingival metastasis

Successful management of rare gingival metastasis from gastric adenocarcinoma: a case report and literature review

Background

Gastric cancer rarely metastasizes to the oral cavity, especially to gingiva. Only 18 cases have been reported worldwide to date. This paper herein presents the nineteenth case of gingival metastasis from gastric cancer.

Case presentation

A 75-year-old man who underwent a radical gastrectomy for gastric adenocarcinoma was admitted to clinical oncology center for gingival mass which was originally diagnosed as epulis. The subsequent positron emission tomography-computed tomography (PET-CT) and histopathological examination revealed a gingival metastatic adenocarcinoma originated from gastric carcinoma. Then three-dimensional conformal radiotherapy (3D–CRT) with synchronization and sequential chemotherapy demonstrated clinical benefit in this patient. Furthermore, this research reviewed the records of 18 cases of gingival metastasis from gastric carcinoma in English, Japanese, and Chinese literature, and summarized the clinicopathologic features of the disease based on previously published papers.

Conclusion

This case suggests that gingival metastasis from gastric cancer is worthy of vigilance. Biopsy and immunohistochemical (IHC) staining should be used for the final diagnosis. Moreover, the patient with uncommon gingival metastatic lesion can be successfully treated by radiotherapy with adjuvant chemotherapy.

Testicular embryonal carcinoma metastatic to the labial mucosa of the upper lip

An unusual case of testicular embryonal carcinoma metastatic to the labial mucosa of the upper lip is reported. The clinical features and the management of the metastatic oral lesion are presented. In patients with known systemic malignancy, oral swellings may be an indication of a metastatic deposit.

Bilateral metastatic spread of testicular teratoma to mandibular condyles

The clinical and radiological features of a patient with metastatic spread of testicular teratoma to both mandibular condyles are presented. It is suggested that in patients with known systemic malignancy, a local metastatic deposit should be considered as a possible cause of unexplained pain in the temporomandibular joints.

Metastases to the oral mucosa: analysis of 157 cases

A review of the English-language literature revealed 157 well-documented cases of metastatic lesions to the oral mucosa. Most (64%) were diagnosed in patients in their fifth to seventh decade. The frequency of the primary site differed between genders: for men it was the lung (35.5%) followed by the kidney (16%) and skin (15%); for women it was the breast (24%) followed by the genital organs (17%). The most common oral site was the gingiva and alveolar mucosa (54.8%) followed by the tongue (27.4%), and with much less frequency by the tonsil, palate, lip, buccal mucosa and floor of the mouth. Of the dentulous patients, 79% exhibited the metastatic tumor in the attached gingiva. The clinical appearance of the metastatic oral lesion in most cases resembled hyperplastic or reactive lesions.

Neoplasms metastatic to the mouth, jaws and surrounding tissues

5% of all malignancies involve the oral cavity. One percent of these malignancies are secondary to neoplasms that are usually found below the level of the clavicles. As it is widely accepted that the jaws do not contain a lymphatic system, it is believed that metastases there occur via the blood stream, a fact that is supported by the occurrence of metastatic foci in areas where spongiosa and slowing of the circulation favour the entrapment of metastatic emboli. This however does not explain why most of the metastases occur in the lower jaw (and in particular in the premolar-molar area) and not in the maxilla, where the spongiosa is more abundant. Batson's plexus has also been mentioned as a possible route of metastasis to the head and neck, thus explaining why, in some cases of metastases, the lungs are not involved, as the blood has not been filtered through the pulmonary bed before reaching the head and neck. In our review of the literature we found 422 metastatic lesions in the mouth, jaws and the surrounding tissues in 365 patients equally divided between men and women. 56.5% of the cases were above the age of 50. In 228 cases there were other metastases as well, whereas in 114 cases the only metastasis found was the one under study. In 22% of the cases, the metastatic focus in our area was the first indication of the existence of an undiagnosed primary malignant tumour somewhere else.(ABSTRACT TRUNCATED AT 250 WORDS)

Multiple gingival metastases from angiosarcoma of the breast

Metastases to the jaws and oral soft tissue occur rarely. Such metastases may result in the presenting symptoms and signs of malignant disease or may develop during the course of a previously diagnosed malignant condition. A case of multiple gingival metastases in a patient with angiosarcoma of the breast is reported.

The differentiation of malignant lymphoma from anaplastic seminoma in a patient presenting with testicular and jaw swelling

The histologic differentiation of anaplastic seminoma from lymphoma is often difficult. In the case presented, a malignant lymphoma showing prominent testicular and jaw involvement was initially interpreted as seminoma. The histologic and ultrastructural criteria for differentiation, as well as a comparison of the clinical and epidemiologic characteristics of these tumors, are discussed. A reassessment of previously reported cases of seminoma metastatic to the jaws/antrum, made relative to these data, suggests that in most cases the tumors may actually be lymphomas.