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Case Reports: Monday, October 24, 2011 |

Metastatic Lung Carcinoma Involving the Maxillary Gingiva FREE TO VIEW

Eva Sawheny, MD; Kellie Jones, MD; Jean Keddissi, MD; Gary Kinasewitz, MD
Chest. 2011;140(4_MeetingAbstracts):79A. doi:10.1378/chest.1117141
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Abstract

INTRODUCTION: Lung cancer is the most common cause of cancer mortality worldwide for both men and women. It often metastasizes, with the most common extra thoracic sites being the liver, adrenal glands, bones, and brain. Metastatic lesions to the oral cavity are extremely infrequent. Gingival metastases are exceptionally rare. Although not life threatening, they may affect oral function and nutrition.

CASE PRESENTATION: A 52 year-old male was referred for evaluation of a left upper lobe mass. He complained of dyspnea, left sided chest wall tenderness, intermittent productive cough, and a 10 lb. weight loss. He denied any hemoptysis, fevers, chills, or night sweats. His past medical history was significant for hypertension and a 28 pack-year history of smoking. His initial physical exam was only significant for poor dentition. Laboratory results were unremarkable. The CT of the chest showed a 4.2x4.4 cm cavitary lesion involving the left upper and lower lobes. He underwent a fine needle aspiration of the mass which was non-diagnostic. Subsequently, the patient complained of tooth pain and was treated with amoxicillin-clavulanic acid for presumed oral abscess. Because of persistent symptoms, he was referred to oral surgery. Exam revealed an erythematous tumor over the anterior maxillary gingiva. Excisional biopsy showed a poorly differentiated carcinoma compatible with metastasis from pulmonary origin (M1b disease). The patient received radiotherapy to the oral lesion, as well as systemic chemotherapy. Despite therapy, he died 4 months after presentation.

DISCUSSION: Metastatic lung cancer to the gingiva is very rare, with 21 cases reported since 1964. Age ranged from 47 to 84 years (median of 59 years). Nineteen of the 21 cases were males, raising the possibility that gender may be a predisposing factor. Gingival metastasis has been observed with all histological subtypes of lung cancer. It may be present initially or occur later with disease progression. In patients with lung cancer, a rapidly growing gingival mass has a broad differential diagnosis including odontogenic infection, cysts, pyogenic granuloma, and benign tumors.

CONCLUSIONS: Metastatic lung cancer to the gingiva is very rare, with 21 cases reported since 1964. Age ranged from 47 to 84 years (median of 59 years). Nineteen of the 21 cases were males, raising the possibility that gender may be a predisposing factor. Gingival metastasis has been observed with all histological subtypes of lung cancer. It may be present initially or occur later with disease progression. In patients with lung cancer, a rapidly growing gingival mass has a broad differential diagnosis including odontogenic infection, cysts, pyogenic granuloma, and benign tumors

Reference #1 R. O’Neil, Bronchial adenocarcinoma presenting as epulis, Brit J Oral Surg 2 (1964), pp. 148-150.

Reference #2 C.I. Adler, G.C. Sotereanos and J.G. Valdivieso, Metastatic bronchogenic carcinoma to the maxilla: report of case, J Oral Surg 31 (1973), pp. 543-546

Reference #3 R.B. Donoff, T. Albert, D.J. Olson and W. Guralnick, Metastatic bronchogenic carcinoma to the mandible, J Oral Surg 34 (1976), pp. 1007-1011.

DISCLOSURE: The following authors have nothing to disclose: Eva Sawheny, Kellie Jones, Jean Keddissi, Gary Kinasewitz

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