Gingival metastasis from primary hepatocellular carcinoma: a case report and literature review of 30 cases.

BACKGROUND: Gingival metastasis from primary hepatocellular cancer (HCC) is rare, highly malignant, and generally has no distinct symptoms. Not performing a biopsy can lead to misdiagnosis. This article reports an 87-year-old male with gingival metastasis from HCC. To gain a better insight into this disease, we also conducted a literature review of 30 cases and discussed the clinical and pathological characteristics, diagnosis, treatment and prognosis of this unusual form of liver cancer. CASE PRESENTATION: An 87-year-old man was hospitalized with a chief complaint of chronic constipation and diffuse lower extremity edema. His past medical history included a three-year hepatitis B infection and a cerebral infarction 17 years prior. Imaging examination detected a massive hepatocellular carcinoma in the right liver lobe and multiple metastases in the lungs. Oral examinations revealed a reddish, cherry-sized exophytic mass on the right upper gum. The mass was tentatively diagnosed as a primary gingival tumor and was ultimately confirmed by biopsy as a metastatic carcinoma originating in the liver. The patient decided, with his guardians, to receive palliative care and not to remove the mass. Unfortunately, the patient accidentally bit the mass open; profuse bleeding ensued and local pressure exerted a poor hemostatic effect. The patient's condition worsened, and he eventually died of multiple organ failure. We also performed a literature review and discussed 30 cases of gingival metastases from HCC. The findings indicated that these lesions affected males more than females, with a ratio of 6:1, and infiltrated the upper gingivae (63.1%) more than the lower gingivae (36.7%). Survival analysis indicated that the overall survival for patients with upper gingival metastasis was worse than for those with lower gingival metastasis, and patients receiving treatments for primary liver cancer or metastatic gingival tumors had better overall or truncated survival times. CONCLUSION: Gingival metastasis from primary hepatocellular carcinoma is rare, and its diagnosis has presented challenges to clinicians. To avoid a potential misdiagnosis, a biopsy is mandatory regardless of whether a primary cancer is located. Early diagnosis and treatment for primary liver cancer or metastatic gingival lesions may improve survival expectations.

Gingival metastasis of a mediastinal pulmonary sarcomatoid carcinoma: a case report.

BACKGROUND: Pulmonary sarcomatoid carcinoma (PSC) is a rare malignancy with both epithelial and sarcoma components, and high tumor metastasis potential. CASE PRESENTATION: A 63-year-old male patient had a tumor in the right posterior mediastinum, and was eventually diagnosed with PSC and gingival metastasis. The patient underwent thoracoscopic right upper pneumonectomy with lymph node dissections, and the subsequent gingival biopsy revealed a metastatic PSC. The immunohistochemistry revealed that both PSC site tissues were positive for vimentin, CKAE1/AE3 and Ki-67. The patient received radiotherapy and chemotherapy after surgery, and deceased two months later due to systemic tumor metastases. CONCLUSION: PSC metastasis is variable, and leads to diagnostic dilemma or erroneous diagnosis. A differential diagnosis can help to distinguish it from gingival cancer.

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

BACKGROUND: Gastric 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 PRESENTATION: A 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. CONCLUSION: This 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.

Clinicopathologic evaluation of malignancy adjacent to dental implants.

OBJECTIVE: The aim of this study was to describe a new case series of peri-implant malignancy, review the literature, and discuss the implications of malignancies resembling peri-implantitis. STUDY DESIGN: This study was a retrospective analysis of cases from 2000 to 2016. RESULTS: Seven patients (two males and five females), aged 44 to 89 years, were included, representing 1.5% of oral malignancy cases. Five cases were squamous carcinoma, one of basal cell carcinoma, and one of carcinoma of metastatic origin. Six cases presented with nonulcerated overgrowth, with bone loss in three and massive osteolysis in one. Misinterpretation as peri-implantitis delayed diagnosis in six cases. Risk factors included previous oral malignancy (2), potentially malignant conditions (2), and smoking (1). Of the 47 cases in the English language literature, 85% were squamous cell carcinoma and 8.5% had distant metastasis. Most cases had one or more risk factors. CONCLUSIONS: Peri-implant malignancy may represent up to 1.5% of oral malignancy cases. Clinical features imitating peri-implantitis may delay diagnosis. Lesions failing to respond to treatment, especially in patients with pre-existing risk factors, should significantly increase suspicion. Histopathology is crucial for diagnosis.

Coughing up - Small cell carcinoma lung with gingival metastasis.

Small cell lung cancer (SCLC) is known for its metastatic potential. The most common sites are liver, adrenal, bone and brain. We report a case of a 37year old female patient, diagnosed with SCLC, presenting with gingival metastasis, an unusual metastatic site. Radiation therapy to the metastatic lesion to a dose of 20 Gray in 5 fractions over 5days was delivered which achieved haemostasis and good palliation. However, the patient expired in 2months owing to systemic metastasis.

Simultaneous gingival squamous cell carcinoma in an oral lichen planus patient.

OBJECTIVE: To describe a case of bilateral simultaneous squamous cell carcinoma of the gingiva affecting the mandible in a lichen planus patient and discuss the pertinent literature. METHOD AND MATERIALS: We present a case of a 50-year-old woman with a history of oral lichen planus who was diagnosed with a primary and a second primary squamous cell carcinoma originating from the mandibular gingiva. A literature review did not disclose cases of gingival carcinoma arising simultaneously and bilaterally in the mandible. RESULTS: Presentation of two simultaneous clinically distinct squamous cell carcinoma of gingiva, invading underlying mandible, is rare. Second primary tumor refers to a concomitant malignancy that is independent from the primary tumor. Second primary tumor is an independent prognostic factor since the surgical procedure is highly influenced by the extent of bony invasion. CONCLUSION: The general practitioner should be aware of the possibility of multiple independent lesions at different sites of the oral cavity. A thorough oral examination of sites remote from the obvious main lesion should be performed. The presence of simultaneous primary oral cancerous lesions may indicate a greater morbidity and a grave outcome for the patient.

Gingival Fibrosarcoma in a Horse.

A 4-year-old thoroughbred cross mare was referred to the University of Edinburgh Veterinary School Equine Hospital for treatment of a soft tissue tumor on the buccal gingival margin of the rostral right maxillary cheek teeth. The lesion was initially surgically excised and diagnosed as a fibrosarcoma via histopathology. Adjunctive treatment with intralesional cisplatin chemotherapy was begun. The tumor recurred and was repeatedly treated with intralesional cisplatin injections and additional surgical resection over the course of 14 weeks. Despite the initial poor response to treatment, no further regrowth of the tumor occurred 3 months following its final treatment. The horse remained free of visible evidence of tumor nearly 5 years later.

Diagnosis, PET/CT imaging, and treatment of extranodal non-Hodgkin lymphoma in keratinized gingiva: a case report.

A 58-year-old patient who smoked and had uncontrolled type 2 diabetes mellitus was referred to our clinic. The patient had a suspicious asymptomatic lesion that was diagnosed as B-cell non-Hodgkin lymphoma (NHL). Immunohistochemistry revealed intense and diffuse expression of CD20, CD10, BCL-6, and Ki-67. A positron emission tomography/computed tomography (PET/CT) scan showed focal pathological uptake of F-18-fluorodeoxyglucose only in the subcutaneous tissue anterior to the left maxillary sinus. After lesion excision and five courses of chemotherapy, PET/CT scans demonstrated complete resolution of the lesion. Smoking, uncontrolled diabetes mellitus, and periodontal disease might be predisposing factors for oral NHL.

Gingival rhabdomyosarcoma in an adult: a unique entity.

Rhabdomyosarcoma is a disease that predominantly affects children. Approximately 40 per cent are located in the head and neck region but it is rare in the oral cavity. This article describes an interesting case of an embryonal rhabdomyosarcoma in a 36-year-old male, involving the mandibular gingiva. The lesion showed radiolucency with ill-defined margins that was crossing the midline. The history revealed a similar lesion six months back at the same site and the lesion had been completely excised. The biopsy reports confirmed the diagnosis of embryonal rhabdomyosarcoma after which en-bloc resection of the tumor was performed with administration of chemotherapy and radiotherapy. Due to high recurrence rate of rhabdomyosarcomas in adults, multimodal therapy should be planned for proper care of the patient. Clinical, radiological, histopathological and management aspects are discussed here.

Gingival metastasis as first sign of multiorgan dissemination of epithelioid malignant mesothelioma.

INTRODUCTION: Metastatic malignant mesothelioma to the oral cavity is extremely rare. They are more common in the jaw bones than the soft tissue. Occurrence of the malignant disease typically carries an average survival rate of 9-12 months METHODS: : Thirteen patients underwent neoadjuvant chemotherapy and radical pleurectomy decortication, followed by radiotherapy from August 2012 to September 2013. Patients were followed up with computed tomography of the chest and the abdomen every 3 months. All patients were followed up until February 2014. RESULTS: In January 2014, 11 patients were still alive with a median survival of 11 months, eight patients developed a recurrence and two patients died at 8 and 9 months after surgery. After 1 year from macroscopic radical pleurectomy decortication, a 68-year-old man suffered from gingival mass turned out to be a metastatic deposit of biphasic malignant mesothelioma as first sign of multiorgan recurrence. The patient underwent chemotherapy and local radiotherapy in the oral cavity. CONCLUSIONS: This case points out the relevance of biopsy to all new growing lesions, even in uncommon anatomical sites, whenever a history of mesothelioma is on record.

Outpatient follow-up appointments for patients having curative treatment for cancer of the head and neck: are the current arrangements in need of change?

Although there are recommendations, there is little evidence about the rationale for the frequency and duration of review appointments for patients with cancer of the head and neck. We have recorded the pattern of follow-up in a tertiary cancer centre and its association with survival and recurrent disease. We used clinical letters and a prospectively maintained database to obtain details on 297 patients who were treated curatively for squamous cell carcinoma (SCC) of the oral cavity between 2005 and 2008. Mean (SD) age was 63 (12) years and 58% (n = 171) were male. Most patients were seen about 6 times in year one, 3 times in year 2, twice in year 3, twice in year 4, once or twice in year 5, and once yearly beyond year 5. Fewer clinics were scheduled for and attended by patients over 75 years of age, those with overall clinical grades 0-1, and those treated by operation alone in contrast to those who also had adjuvant radiotherapy. Patients were usually seen about 15 times over the 5 years. Taking into account the stage of the tumour and overall mortality, the number and timing of follow-up visits is adequate for the needs of patients with stage II-IV disease. Those with stage I disease may be considered for discharge after the third year if they are told about the risk factors, and signs and symptoms of recurrent disease, and surveillance in primary care.

Squamous cell carcinoma of the superior gingivobuccal sulcus: an 11-year institutional experience of 203 cases.

OBJECTIVE: The report presents an 11-year Institutional experience of 203 cases with superior gingivobuccal sulcus tumours receiving surgical intervention at a comprehensive tertiary cancer care centre. METHODS: A retrospective chart review of patients with a confirmed diagnosis of squamous cell carcinoma of superior gingivobuccal sulcus was done and data related to patient demographic profile; details of surgical procedure, follow-up and survival were collected. RESULTS: Infratemporal fossa clearance was performed in 56 patients. The 10-year overall survival and disease-free survival was observed to be 39 and 52%, respectively, with a median follow-up of 15 months. The overall survival was 40 and 36%, respectively, in cases with and without infratemporal fossa clearance. Similarly, the disease-free survival was found to be 58 and 49%, respectively, in cases with and without infratemporal fossa clearance. CONCLUSION: Patients with higher stage tumours who underwent infratemporal fossa clearance showed better overall and disease-free survival than those who did not undergo infratemporal fossa clearance.

Left maxillary artery pseudoaneurysm: a rare and late postoperative complication after head and neck cancer treatment.

We report a case of a 50-year-old man presented with pulsatile swelling in the left side of the face since 2 months and a continuous sinus discharge since 3 days. Three years earlier, he was operated for squamous cell carcinoma (SCC) of the left lower alveolus and underwent surgical excision with myocutaneous flap reconstruction, followed by chemoradiotherapy. CT angiogram of the expansile swelling revealed pseudoaneurysm of third part of the left maxillary artery and treated by surgical intervention.

[A case of appearance of a prominent rash in response to alternate-day S-1 administration as adjuvant chemotherapy for lower gingival cancer].

We report the development of a prominent rash in response to alternate-day S-1 administration in a patient with oral cancer. The patient was a 75-year-old woman with left-side lower gingival cancer(T4N1M0). After chemoradiotherapy, the patient underwent radical surgery. She was treated with oral S-1, administered on alternate days at a dosage of 80mg/day (orally, twice per day), as postoperative adjuvant chemotherapy. Edematous erythema, accompanied by strong itching and paraesthesia, appeared focally on the face and the limbs 1 month after beginning S-1 treatment. Since the rash was determined to be drug-induced, S-1 administration was stopped, and steroid, antihistamine, and topical steroid treatment was initiated. The symptoms gradually improved, and the rash disappeared without recurrence approximately 1 month later. Although alternate-day administration is considered to be a safe and effective method to administer S-1 oral therapy, it should be noted that cutaneous symptoms might appear after a fixed dosage is exceeded.

Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy for gingival carcinoma.

PURPOSE: The aim of this study was to review the efficacy and toxicity of radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy in the treatment of gingival carcinoma. METHODS AND MATERIALS: In all, 34 patients (21 men and 13 women) with squamous cell carcinoma of the gingiva underwent radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy. Treatment consisted of daily external irradiation and concurrent retrograde superselective intra-arterial infusion with cisplatin and docetaxel. A median total dose of 60 Gy in 30 fractions was delivered to tumors. RESULTS: Of the 34 patients, 29 (85 %) achieved a complete response (CR) and 5 had residual tumors. Of the 29 patients with a CR, 2 had local recurrences and 1 had distant metastasis 1-15 months after treatment. Twenty-six of the 36 patients had survived at a median follow-up time of 36 months (range 12-79 months); 4 died of cancer and 4 died of non-cancer-related causes. At both 3 and 5 years after treatment, the overall survival rates were 79 % and the cause-specific survival rates were 85 %. Osteoradionecrosis of the mandibular bone only developed in 1 patient after treatment. CONCLUSION: Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy was effective and safe in the treatment of gingival carcinoma. This treatment may be a promising curative and organ-preserving treatment option for gingival carcinoma.

Perinatal management of congenital oropharyngeal tumors: the ex utero intrapartum treatment (EXIT) approach.

PURPOSE: To present our experience in the perinatal management of fetuses with large oropharyngeal tumors by ex utero intrapartum treatment (EXIT). METHODS: We performed a retrospective chart review of all patients with congenital oropharyngeal tumor who underwent an EXIT procedure between May 2006 and June 2012. RESULTS: Four patients were included in the series, three females and one male. The diagnoses were epignathus (n=2) and congenital epulis (n=2). Three EXITs were done at term and one at late preterm due to premature rupture of membranes. Median maternal time under anesthesia was 185 min (range: 166-281) and median maternal operative time was 99 min (range: 85-153). Median maternal blood loss was 550 ml (range: 350-2000); one mother required a blood transfusion. Mean maternal hospital stay was 4 days. Median hysterotomy-to-cord clamp time was 24 min (range: 18-66). Mean fetal birth weight was 2.7 kg (range: 2.4-3). The airway was successfully accessed and secured under placental circulation in all cases. In the two patients with congenital epulis the tumors were resected at the base of their pedicles and the airway accessed via direct laryngoscopy before the umbilical cord was clamped. One patient with epignathus underwent a retrograde tracheal intubation under placental circulation and had the tumor resected thereafter. The second patient with epignathus had a tracheostomy done under placental circulation and then had tumor debulking immediately after the EXIT. The maternal morbidity was minimal and there were no mortalities. CONCLUSIONS: We conclude that the EXIT procedure is the ideal delivery strategy for fetuses with prenatally diagnosed oropharyngeal tumors and potential airway obstruction at birth. Patients with prenatally diagnosed oropharyngeal tumors should be promptly referred to a fetal treatment center with a dedicated multidisciplinary team and EXIT capabilities.

Combined intra-arterial infusion and systemic chemoradiotherapy for stage IV squamous cell carcinoma of the mandibular gingiva.

PURPOSE: The purpose of this study was to show the effectiveness of combining intra-arterial infusion and systemic chemotherapy with concurrent radiotherapy for treatment of stage IV mandibular gingival cancer. MATERIALS AND METHODS: A total of 23 patients with mandibular gingival cancer were treated with either docetaxel by intra-arterial infusion followed by systemic chemoradiotherapy with cisplatinum and 5-fluorouracil as a monthly regimen, or with docetaxel and cisplatinum by intra-arterial infusion followed by systemic chemoradiotherapy with 5-fluorouracil as a weekly or biweekly regimen. Tumor responses, locoregional control, overall survival, disease-specific survival, and adverse events were evaluated. RESULTS: Of the 23 patients enrolled in the study, 22 completed the treatment. With regard to clinical stages, 82 % were diagnosed as IVA and 18 % IVB. Complete and partial response was observed in 82 and 18 %, respectively. Five-year overall survival, disease-specific survival, and locoregional control were 51, 70, and 72 %, respectively. No statistically significant difference was seen between the monthly regimen and the weekly plus biweekly regimen, although the latter resulted in longer survival and 88 % control. CONCLUSION: Combined intra-arterial infusion and systemic chemoradiotherapy may be an effective treatment for patients with stage IV mandibular gingival cancer.