原文題目(出處)： Mucinous adenocarcinoma of lung presenting as oral metastases: A case report and literature review. J Endod 2011;37:110-3
原文作者姓名： Rozet Tatlidil, M Murat G
通訊作者學校： Bilim Imaging Laboratory and Dental Clinic, Izmir, Turkey 報告者姓名(組別)： 林俊國 (Intern G 組)
報告日期： 100.02.07
內文：
Metastases of malignant tumors to oral regions are far less common than primary lesions.
Only 1% of oral tumors are metastatic; the majority of these are jaw lesions.
Metastasis to gingival and other soft tissues is very rare.
However, a lesion in the oral cavity may be an initial indicator of a systemic malignancy
I. Case Report
The case was a 50-year-old woman who had no habit of smoking and no history of medical problems.
She complained of swelling and slight pain in the right lower mandible and consulted her dentist
Histological examination:
Two white-gray–colored round, mucinous cysts, not typical radicular cysts, each close to 1 cm, were removed from the periapical region of the first molar tooth.
Within and adjacent to the fibrinous tissue, there was a tumor consisting of adenoid structures of columnar epithelial cells with prominent nuclei.
Papillary structures and mucus were found within the lumen of the adenoid tissue
Treatment course:
The patient was referred to a positron emission tomographic (PET) to search for the primary tumor, and to assess the extent of the disease.
The PET scan showed a hypermetabolic 5-cm tumor mass and a 2-cm adjacent satellite lung lesion within the right upper lung. No additional lesions were seen throughout the whole body
upper lobectomy
Partial right mandibular resection and reconstruction with metallic plate.
Systemic chemotherapy
The patient died of metastases after 1 year.
II. Discussion
The early clinical manifestation of a metastatic lesion can resemble a hyperplastic , exophytic lesion such as pyogenic granuloma or epulis Unusual in a number of aspects
1. The patient consulted her dentist for jaw pain and did not complain of other medical or pulmonary symptoms
2. There was swelling on the right lower jaw, with a smooth surface resembling an abscess on the initial consultation. There was pus following the small incision of the gingival surface indicating periodontal infection. After antibiotic treatment, pain and swelling reduced minimally. Luxated crowns were then removed.
Unusual but benign-looking mucinous cysts were curetted and proven to harbor metastasis.
3. There were multiple metastatic sites throughout the body in addition to oral cavity metastases and primary tumor. In our case, the metastasis to the tooth root was the only metastatic site.
4. Most of the previous cases described as metastases to the oral region from a lung carcinoma consisted of male patients.
Metastasis around dental implants has been reported before .Local factors have an influence on the growth of metastasis; trauma has been observed to facilitate the growth of blood-borne metastasis
A review of literature included cases reported between 1926 and 1992 . Of 55 patients, the most common primary tumor sites were the lung, breast, and colon.
Breast cancer in females and lung cancer in males are the most common malignant tumors metastasizing to the oral mucosa.
Metastatic lesion was the first sign of the systemic malignant disease in 35% of patients.
In 65% of cases, the metastasis was diagnosed in the presence of a known cancer.
Most patients complained of swelling and pain, and some complained of lower-lip numbness.
In 91% of cases, the tumors were epithelial; the remaining 9% were mesenchymal in origin
III. Conclusions
Benign-looking cysts can be an indication of metastases from other parts of
the body.
However, if some atypical changes in the oral cavity are present, it is important to do further tests and examinations
題號 題目
1 若口腔內出現轉移癌(metastatic carcinoma),最常發生在口腔硬組織
的哪個部位?
(A) 上顎骨(maxilla) (B) 下顎骨(mandible) (C) Both
(D) None of the above
答案( B ) 出處：Oral & Maxillofacial PATHOLOGY (SECOND EDITION) P582
題號 題目
2 若肺癌轉移到口腔比較可能轉移的路徑是從哪個通路轉移?
(A) Lymphatic route (B) Hemtaogenous route (C) Both
(D) None of the above
答案( B ) 出處：Oral & Maxillofacial PATHOLOGY (SECOND EDITION) P489
