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

Abstract

BackgroundGastric 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 presentationA 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.ConclusionThis 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.

The “Epulis” Dilemma. Considerations from Provisional to Final Diagnosis. A Systematic Review

“…Localized chronic gingival enlargements are frequently detected by clinicians and the management requires a rational approach. These neoformations occur with the following characteristics [1][2][3][20][21][22][23][24][25][26][27][28][29][30][31][32][33]35,36 A careful collection of data regarding the medical history of the patient must always be the first step to take in the process that will lead the clinician to the final diagnosis. Sometimes the medical history might be not relevant at all, whereas at other times it might be of great help.…”

“…Fukuda et al [38] suggested that the criteria for considering an oral malignant neoplasm as metastatic are: a primary tumor with histologic verification, a second oral lesion histologically relevant to the primary tumor, a histopathologic appearance of the oral lesion distinct from that of a typical oral malignancy and exclusion of a possible direct extension from the primary tumor. Kawamura et al [23], Moser et al [26], Wu et al [33], Shah et al [28] and Chiarelli et al [21] reported the occurrence of gingival metastasis. Kawamura et al [23] treated a patient who previously underwent a surgical procedure for poorly differentiated rectal carcinoma.…”

Metastatic tumors to the oral cavity – A retrospective analysis

“…They affect jawbones more frequently than oral mucosa and the ratio is 2:1 [2,8] . When the metastatic tumor involves the jawbones, it is usually located in the mandible but when it involves oral soft tissues, the maxillary gingivae is more often affected than the mandibular [9] . Two-thirds of oral metastasis cases occur in the context of widespread disease and one-third of the cases represents the first clinical manifestation of an unknown primary [10] .…”

Perfil De Conhecimento E Condutas Em Biossegurança De Uma População De Acadêmicos De Odontologia

“…Qualquer neoplasia maligna pode promover a formação de tumores metastáticos para os tecidos do sistema estomatognático, no entanto, a literatura mostra uma maior ocorrência de TMSE associados a neoplasias primárias localizadas em mama, próstata, pulmão, tireoide e rim, perfazendo cerca de 70% dos casos (WU et al, 2017) As metástases de carcinomas pulmonares são mais frequentemente detectados em estágio metastático IV em localizações extra-gnáticas como o fígado, ossos, glândulas suprarrenais e cérebro, no entanto, sugere-se que as lesões metastáticas para a região de cabeça e pescoço usualmente associam-se a tumores primários localizados nos pulmões, com destaque para o carcinoma de células escamosas, seguido do adenocarcinoma (DJERIC et al, 2015;CHENG et al, 2017;MATSUDA, 2018;RADZI, TAN, 2018). Por outro lado, sugere-se que tumores primários do pulmão, pleura, brônquios, esôfago, cólon, mama e pele geralmente metastatizam para a língua (DANIC, DANIC, MACAN, 2018).…”

“…Metástases em tecidos moles orais geralmente se manifestam como lesões ulceradas ou massas causando tumefação, com rápido crescimento, sintomatologia dolorosa, dificuldade de mastigação, disfagia e sangramento intermitente (ASWATH et al, 2017;WU et al, 2017;SOARES, 2018). Na boca, alguns casos de metástases podem assemelhar-se a lesões aparentemente inócuas como o granuloma piogênico (WU et al, 2017;SOARES, 2018;PELISSARI et al, 2018).…”