Hidden colon adenocarcinoma diagnosed from mouth metastasis: case report and literature review

Abstract

Background We report an unusual case of metastatic colon adenocarcinoma to the maxilla as an initial clinical sign of the disease, this being the second case reported in the palate. In addition, we show an extensive review of the literature, with clinical cases of adenocarcinoma with metastasis to the mouth. Case presentation An 80-year-old man complained of “swelling on the palate” with a 3-week evolution time. He reported suffering from constipation and high blood pressure. The intraoral examination revealed a pedunculated, red, and painless nodule on the maxillary gingiva. Under the diagnostic hypotheses of squamous cell carcinoma and malignant neoplasm of the salivary gland, an incisional biopsy was performed. Microscopically, the columnar epithelium was observed forming papillary areas, neoplastic cells with prominent nucleoli, hyperchromatic nuclei, atypical mitotic figures, and mucous cells, being positive for CK 20, suggesting the provisional diagnosis of metastatic adenocarcinoma, probably of gastrointestinal origin. The patient was submitted to endoscopy and colonoscopy exams, and a lesion in the sigmoid region of the colon was observed. After a colon biopsy, a moderately differentiated adenocarcinoma was confirmed, establishing the final diagnosis of metastatic neoplasia of colon adenocarcinoma to the oral lesion. The literature review revealed 45 clinical cases of colon adenocarcinoma with metastasis to the oral cavity. To the best of our knowledge, it is the second case on the palate. Conclusions Colon adenocarcinoma with metastasis to the oral cavity is rare but should be included in the differential diagnosis of neoplasms of the oral cavity, even when there are no known primary tumors in some cases, and this may be the first indication of the presence of a tumor.

Hyoid Bone Metastases: An Unusual Case

“…Gastrointestinal adenocarcinoma metastases to unusual sites, such as paranasal sinuses, cryptorchid testis and in maxilla, with complaints of "swelling on the palate", are also reported in the literature [14,15]. Oral adenocarcinoma metastases had a median survival of 6 months after diagnosis.…”

“…Oral adenocarcinoma metastases had a median survival of 6 months after diagnosis. A differential diagnosis between oral adenocarcinoma metastasis and squamous cell carcinoma, salivary gland tumor or pyogenic granuloma must be considered [15].…”

A Case Report of Mandibular Gingival Metastasis From Sigmoid Colon Adenocarcinoma With Phenotypical Transformation Into Neuroendocrine Carcinoma

“…The venous systems of the neck, thorax, abdomen, and pelvis are connected by a valveless venous plexus. An increase in pressure in the abdominal cavity can create a venoflow in a cranial direction with the transfer of metastatic cells to the jaws [ 14 ]. Such an increase in intra-abdominal pressure can be caused both by a volume-occupying tumor process in the area and by various operative interventions, factors that are present in the case described by us, in which resection of the sigmoid colon, total hysterectomy, lymphatic dissection, liver biopsy, and resection of the ileum was done.…”

“…Advances in imaging, molecular profiling, and immunohistochemistry help define the primary focus and treatment options [ 2 ]. The final diagnosis is based on the histological examination, clinical examination, and paraclinical examination including imaging studies and immunohistochemical analysis [ 14 ]. The current case was diagnostically challenging, as the lesion showed no evidence of glandular morphology in contrast to the primary neoplasm.…”

Metastatic colon carcinoma in the maxilla: Highlighting the importance of perioperative oral management: A case report

“…Metastatic tumors in the oral region are extremely rare, constituting <1% of all malignancies ( 1 , 2 ). They primarily affect individuals aged 50-70 years-old, with no significant sex disparity.…”