title: Exophytic mass of the gingiva as the first manifestation of metastatic pulmonary adenocarcinoma.
abstract: BACKGROUND
  Metastasis of a malignant tumor to the oral cavity is rare, but it can be the first manifestation of a primary tumor.
  
  
  METHODS
  The clinicopathologic features of a gingival metastasis originating from lung adenocarcinoma in a female patient are described. A 57-year-old woman showed a rapidly growing, painless, exophytic mass in the left mandibular gingiva. The whole lesion was excised, and histologic and immunohistochemical analyses were performed.
  
  
  RESULTS
  The histopathologic sections showed a proliferation of poorly differentiated spindle and pleomorphic cells. Because the differentiation between carcinoma and sarcoma of spindle cell tumors was difficult, additional immunohistochemical evaluation was performed. The intraoral healing after tumor removal was uneventful. The discrepancy between the histopathologic results and the clinical findings led to a thorough examination by the patient's physician. Finally, a biopsy of the lungs confirmed a poorly differentiated adenocarcinoma with multiple metastases, including the oral cavity.
  
  
  CONCLUSIONS
  An exophytic lesion on the gingiva can be the first sign of metastatic adenocarcinoma to the oral mucosa. This case emphasizes that even apparently benign-looking gingival lesions in anamnestically healthy patients need to be examined histopathologically.
authors.affiliation: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Elena C Ferrazzini
authors.initials: EC
authors.lastname: Pozzi
authors.forename: Hans Jörg
authors.initials: HJ
authors.lastname: Altermatt
authors.forename: Terry D
authors.initials: TD
authors.lastname: Rees
authors.forename: Michael M
authors.initials: MM
authors.lastname: Bornstein
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D001706:Biopsy; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D005887:Gingival Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D018398:Homeodomain Proteins / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D053552:Keratin-7 / Q000032:analysis; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008334:Mandible; D008875:Middle Aged; D009687:Nuclear Proteins / Q000032:analysis; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors / Q000032:analysis
chemical_list: D018398:Homeodomain Proteins; D053552:Keratin-7; D009687:Nuclear Proteins; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors