Exophytic mass of the gingiva as the first manifestation of metastatic pulmonary adenocarcinoma.
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.
Pozzi
Elena C Ferrazzini
EC
Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
Altermatt
Hans Jörg
HJ
Rees
Terry D
TD
Bornstein
Michael M
MM
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
D018398:Homeodomain Proteins; D053552:Keratin-7; D009687:Nuclear Proteins; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors