Metastasis within the buccal cavity is an uncommon manifestation of non-head and neck tumors. Hard palate metastasis often have been associated with melanoma and lymphomas. We present the first case of a hard palate mass as the first manifestation of lung adenocarcinoma.
A 43 year-old female smoker presented with an enlarging, intermittently bleeding hard palate mass and 70 pound weight loss over a period of 2 months. She denied pulmonary symptoms. She had a 25 pack-year tobacco history. Physical examination was significant for a large mass on her hard palate and decreased breath sounds of the right lung base. Magnetic resonance imaging of the oral area revealed a large enhancing mass centered on the right hard palate with invasion into the right maxillary sinus, pterygopalate fossa, and the masticator space. Chest computed tomography revealed narrowing in the right lower lobe bronchus, subcarinal and bilateral hilar lymphadenopathy, and a right pleural effusion. Pleural effusion cytology was negative for malignant cells. Bronchoscopy revealed an endobronchial mass in the superior segment of the right lower lobe. Transbronchial needle aspirate of the subcarinal area and a hard palate biopsy of the mass revealed poorly differentiated adenocarcinoma. Thyroid transcription factor marker (TTF-1) of the hard palate biopsy was positive indicating that lung adenocarcinoma was the primary malignancy. She received chemoradiation with partial remission of her oral obstruction.DISCUSSION: Lung cancer rarely metastasizes to the hard palate. Malignant melanoma is the most common malignancy to metastasize to the hard palate, but has also been reported with other organ malignancies including renal cell cancer, colon cancer, lymphomas, gastric cancer, small cell lung cancer and follicular thyroid carcinoma.
Metastasic hard palate lesions are unusual. Lung cancer should be considered in the differential of patients with hard palate masses.
P.E. Molina, None.