Gastric cancer with metastasis to the gingiva

Abstract

The present case report describes a gastric cancer which showed unusual metastasis in the oral region. A 56-year-old male patient underwent total gastrectomy and splenectomy due to advanced gastric cancer in the upper third of the stomach. Fifteen months later, he presented with anorexia and gingival swelling of durations of approximately 3 and 1 month, respectively. The gastric tumor was histologically a signet ring cell and a poorly differentiated cancer with a moderate degree of vascular invasion. Biopsy specimens from the gingival tumor revealed a signet ring cell cancer. Other metastatic sites were the brain, limb bones and abdominal lymph nodes. A bone scintigram revealed an abnormal uptake in the limb bones, while it did not exhibit any abnormality in the oral region. Correlation between the histology of the gingival tumor with that of the gastric cancer, as well as the absence of a gingival tumor at the time of prior gastrectomy, led to a diagnosis that the gingival tumor was a metastasis from gastric cancer. Gastric cancer metastasizing to the oral region, either the osseus or the oral soft tissue, is very rare. Although it cannot be proved without an autopsy, negative findings in the mandible by bone scanning in the present case suggest that direct gingival metastasis can be considered, rather than mandibular metastasis involving the gingiva. Hematogenous spread could be a mechanism of metastasis for this unusual tumor.

Oral ulcer as an exclusive sign of gastric cancer: report of a rare case

“…indicating that the route of metastasis might be hematogenous [9], our case also showed moderate venous invasion by gastric carcinoma cells in the resected stomach, which could explain the oral lesion. In this regard, we agree with other authors who consider patients with oral metastases as having a poor prognosis because of aggressive disease, but it is unclear whether our patient's disease was really widespread at the time of its first manifestation in the gingiva [9-11]. …”

“…Our case is interesting because the metastatic lesion of the palate was diagnosed before the discovery of the primary tumour, whereas most other previously published reports involve gastric cancers that were already known or simultaneously discovered at the time of the manifestation of the oral lesion [4,5,8,9]. Only Lopez and Arjona have described a case like ours in which the patient developed a gingival lesion before any clinical or pathological evidence of the primary tumour was found [6,7].…”

“…Metastatic lesions of gastric origin in the orofacial region are extremely rare, particularly when restricted to oral soft tissues and, in all of the very few cases published in the English literature, the diagnosis of gastric cancer was delayed because of its uncommon clinical presentation (see Table 1) [4-9]. …”

Gingival metastasis of ovarian carcinoma: report of a case and review of the literature

“…Elkhoury et al reviewed the English literature from 1991 to October 2003 and found an additional 22 cases of reported metastases to the gingiva 7 . A review of the English literature from October 2003 to November 2007 revealed an additional 8 cases of metastases to the gingiva 1,5,8,15,16,18,21,22 to bring the total number since 1916, including the present case, to 117 cases. These 117 cases, listed according to the primary site of metastases, are summarized in Table 1.…”

A case report of metastatic adenocarcinoma of the gingiva

“…Cases of intraoral metastasis have been reported from primary chondrosarcoma of femur,[9] adenocarcinoma of lung,[10] gastric cancer[11] and hypernephroma. [12] This is a case report of a patient with adenocarcinoma of the lung which metastasized to left posterior buccal and lingual gingiva.…”