Metastatic renal clear cell carcinoma masquerading as a pyogenic granuloma on the lip.

Metastases to the face are rare. We report on a patient with a history of renal cell carcinoma who presented with a 1.2cm violaceous papule on his lower lip. Although clinically thought to be a pyogenic granuloma, biopsy revealed metastatic renal cell carcinoma recurring after 7 years of latency.

Immunoexpression of human leukocyte antigen-DR in actinic cheilitis and lower lip squamous cell carcinoma.

The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Immunoexpression of human leukocyte antigen-DR in actinic cheilitis and lower lip squamous cell carcinoma

Abstract The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Upper lip metastasis of sarcomatoid carcinoma of the lung - an unusual site of disease: a case report.

BACKGROUND: Lip metastases are rare clinical events that are frequently mistaken for other diagnoses. For sarcomatoid lung carcinoma, a rare histologic variant of non-small cell lung cancer, the incidence and pattern of cutaneous spread is poorly understood. CASE PRESENTATION: We present a case of a 79-year-old African American man with a rapidly progressive upper lip cutaneous lesion that provided the first evidence of distant metastatic spread of sarcomatoid lung carcinoma. CONCLUSIONS: This is the first reported case of lip metastasis in sarcomatoid lung carcinoma. It highlights the importance of maintaining a high level of suspicion for metastatic disease in the presence of new cutaneous findings as they may be the first evidence of advanced disease.

Predictive model of oral cancer metastasis for different cancer sites and age groups.

AIM: The high incidence rates for oral cancer (excluding lip) are especially found in the South and South-East Asia. Therefore, the aim of the present study was to investigate the relationship between sex, age, site, and metastasis of a large sample with oral squamous cell carcinoma (OSCC). METHODS: A total of 989 OSCC treated with neck dissection were selected. All the relevant data were recorded from biopsy request forms. The patients were divided into seven groups, and there were nine different oral sites. RESULTS: The male-to-female ratio of the sample was 4:1. Most of the patients were aged between 30 and 60 years. Of the 989 patients, approximately 40% patients had metastasis. Age <30 years showed a higher probability of metastasis compared to higher age groups, but it was not statistically significant. Palate cancers had more than 14 times higher chance of metastasis, followed by maxilla (4.6 times) and tongue (2.8 times). CONCLUSION: The present study provides important information on the metastatic potential of OSCC in different oral sites, and identifies high-risk age groups for metastasis. This will be helpful in planning neck treatment for OSCC.

An atypical metastasis of renal clear cell carcinoma to the upper lip: a case report.

Metastatic lesions of the oral cavity are extremely rare, accounting for approximately 1% of all malignant oral tumors. Renal clear cell carcinoma (RCCC) constitutes about 3% of the solid tumors in adults. It is the third most frequent neoplasm to metastasize to the head and neck region, preceded by breast and lung carcinoma. Because of the silent growth of this neoplasm, most patients are asymptomatic and are diagnosed in an advanced stage, frequently with metastases. We report an unusual case of a 60-year-old male patient with an ulcerated nodule on the upper lip mimicking a keratoacanthoma. He was treated for left-sided RCCC 5 months earlier. The lesion was excised, and the histopathologic findings were suggestive of metastatic RCCC. The clinical features, prognosis, and treatment modalities for metastatic lesions are reviewed in our report. This case is a rarity because only 3 cases of metastatic RCCC of the upper lip have been reported in the literature.

Unusual metastasis of esophageal cancer.

INTRODUCTION: Carcinoma of the esophagus is in the eighth place by the frequency of malignant diseases and the sixth cause of death from cancer worldwide. It usually metastasizes to regional lymph nodes, liver, lungs, central nervous system, and bones, but metastases can appear to unusual locations such as facial skin and lips. CASE REPORT: We presented a 56- year-old man who reported to his physician because of upper lip swelling. A physical checkup of the patients also showed a lesion on the skin of the left temporal region and both lesions were biopsied. Based on the results of histopathological and immunohistochemical analyses of the samples a diagnosis of metastatic adenocarcinoma to the skin was established. Additional diagnostic procedures, including esophagogastroduodenoscopy, detected the infiltration into the distal part of esophagus, which was histopathologically confirmed as adenocarcinoma of esophagus. The results of positron emission tomography/computed tomography (PET/CT) examination showed the invasion of the disease. Because of the disease expansion, a multidisciplinary oncology team suggested chemo- and radiotherapy treatment. The patient has received 4 cycles of platinum-based chemotherapy so far. CONCLUSION: The physicians should always consider unusual skin lesions as the first sign of cancer spreading.

[A case report of hepatocellular carcinoma with metastases to the lip, stomach, and colorectum].

A 79-year-old man was diagnosed with hepatocellular carcinoma in 2000 and treated with partial hepatectomy. Intrahepatic carcinoma recurred with lung metastases 7 years later. Several transcatheter arterial chemoembolizations were performed to treat the recurrence, and a right lower lobectomy was performed for lung metastasis. Twelve years after the original carcinoma diagnosis, lip and lung metastases were detected, and he was hospitalized for radiotherapy of the lung metastasis; an oral molecular-targeting drug was initiated. During the therapy, hematochezia was observed, and a colonoscopy was performed. A submucosal lesion with a blood clot measuring approximately 4mm in diameter was found in the sigmoid colon, and endoscopic mucosal resection was performed. Furthermore, an elevated lesion with a 5-mm diameter recess was observed on upper gastrointestinal endoscopy. Both lesions were diagnosed histopathologically as hepatocellular carcinoma metastases.

Labial mucosa metastasis of fibule giant cell-rich osteosarcoma: an unusual presentation.

Oral metastases from osteosarcoma are rare, particularly in the soft tissues of the oral cavity. The aim of the current case is to present a patient with labial mucosa metastasis from a long bone osteosarcoma and review the literature. A 55-year-old man who had a recent leg amputation because of a giant cell tumor presented a lesion in the lower labial mucosa. After histopathologic and immunohistochemical analysis the diagnosis was of an undifferentiated sarcoma. The patient quickly developed other lesions on the scalp and on the hand, and biopsy of one of these lesions rendered the diagnosis of a giant cell-rich osteosarcoma. Reviewing all information, it was concluded that the leg tumor was the primary giant cell-rich osteosarcoma misdiagnosed as a giant cell tumor. This case emphasizes the importance of the general clinicians' multidisciplinary approach and association of information to arrive at the proper diagnosis, particularly in rare and difficult situations.

Immunoexpression of bone morphogenetic protein-2 (BMP-2), BMP receptor type IA, and BMP receptor type II in metastatic and non-metastatic lower lip squamous cell carcinoma.

BACKGROUND: The aim of this study was to evaluate the expression of bone morphogenetic protein-2 (BMP-2), BMPR-IA, and BMPR-II in metastatic and non-metastatic lower lip squamous cell carcinoma (LLSCC). METHODS: Twenty LLSCC with regional nodal metastasis and 20 LLSCC without metastasis were selected for analysis of the immunoexpression of BMP-2, BMPR-IA, and BMPR-II. The percentage of positive cells was evaluated according to the following parameters: score 1 (staining in 0-50% of cells), score 2 (staining in 51-75% of cells), and score 3 (staining in >75% of cells). Immunostaining intensity was evaluated according to the following scores: score 1 (absent or weak expression) and score 2 (strong expression). RESULTS: Regarding the percentage of positive cells, most tumors with and without metastasis showed score 3 for both BMP-2 (P = 0.655) and BMPR-IA (P = 0.655). For BMPR-II, metastatic tumors exhibited higher percentage of positive cells in comparison with non-metastatic tumors (P = 0.049). With respect to immunostaining intensity, most LLSCCs with and without metastasis showed score 2 for BMP-2 (P = 1.000) and score 1 for BMPR-II (P = 1.000). For BMPR-IA, most metastatic tumors presented score 2, whereas most non-metastatic tumors showed score 1 (P < 0.001). Strong expression of BMPR-IA showed a statistically significant association with advanced clinical staging (P < 0.001) and high score of malignancy (P = 0.028). CONCLUSIONS: The results of this study suggest that disturbances in the BMP-2 signaling pathway may be involved in the development of LLSCC and that the strong expression of BMPR-IA might be indicative of the development of metastasis in these lesions.

An upper lip tumour as the presenting symptom of metastatic renal cancer.

INTRODUCTION: Renal cell carcinoma (RCC) constitutes about 3% of solid tumours in adults. Unfortunately, in spite of continuous development of more and more efficient diagnostic methods, in about 30% of patients with RCC metastatic spread is found at presentation. Only in 1% of patients with advanced RCC metastases are limited exclusively to the head-and-neck region. We present a case of a male patient in whom a tumour of the upper lip was the first symptom of advanced renal cancer. CASE REPORT: A 59-year-old male was admitted to the Urology Department due to a large tumour of the right kidney. About two months earlier the patient noted a nodule located within the upper lip. In the same period painless hematuria occurred twice, which was disregarded by the patient. A CT scan of the chest and abdomen showed a large tumour of the kidney, multiple lung and bone metastases. The patient underwent local surgical excision of the lip tumour and palliative renal artery embolization. CONCLUSIONS: In natural history of renal cancer there is a risk of metastatic spread to the head-and-neck region. Contrast enhanced computed tomography of the abdomen should be considered if a tumour of unknown origin is found within the head-and-neck region. Prognosis in case of confirmed metastatic renal cancer is unfavourable and patient's treatment should be conducted in specialist centres.

Metastatic colorectal carcinoma: an unusual presentation.

Cutaneous metastases from colorectal carcinomas occur infrequently, usually in the setting of disseminated disease. They most commonly appear on the abdominal wall or perineal area; metastases to other locations of the skin are rare. We describe a case of colorectal signet ring carcinoma with metastasis to the upper lip. To the authors' knowledge, this is the second reported case of colorectal carcinoma with metastasis to the lip and first with signet ring features. Because of the rarity of cutaneous metastases, the primary physician or pathologist may overlook this diagnosis. However, this entity should be considered in the differential diagnosis of adnexal tumors as it may be the initial presentation of the colon carcinoma.

Malignant mesothelioma presenting as a lip tumor: report of two cases with one unrecognized by 166 pathologists.

Malignant mesothelioma is a relatively uncommon malignancy, but continues to increase in incidence in many countries around the world, including Australia.