Kwang-Sup Shim

Gingival Metastasis from Gastric Adenocarcinoma

The oral cavity is a rare but occasional target for metastases, which may masquerade as various benign and inflammatory lesions. Also, occult cancer may metastasize to the oral cavity as a first and exclusive manifestation. It is important to bear these possibilities in mind because such situations may be encountered during a routine examination of the head and neck region. A 58-year-old man was referred to the Department of Dentistry/Oral and Maxillofacial Surgery because of a 2-month history of a painful swelling of upper right first molar area. Past medical history was significant for subtotal gastrectomy for adenocarcinoma of the stomach (stage IIIa: T3 N1 M0) at the age of 54. Following surgery, he received six cycles of chemotherapy with 5-fluorouracil, adriamycin, and mitomycin-C. At that time, no metastasis was found on abdominal computed tomography (CT) scan. Six months later, abdominal CT and endoscopic examination showed no recurrence or metastasis. However, 4 years later, pulmonary and hepatic metastases appeared, and whole body bone scan detected multiple metastatic rib, pelvis, and femoral bone lesions. Consequently, the patient was admitted for chemotherapy and referred to our department during the chemotherapy. Clinically, intraoral examination revealed soft tissue swelling, resembling periodontal pyogenic abscess of granuloma-like hyperplastic lesions. The lesion was located on the buccal gingiva and vestibule and measured approximately 3.0 2.0 cm (Fig 1A). The exophytic growth, in the first and second molar region, was associated with pain, foul odor, and a bloody and necrotic tag. The extraoral head and neck examination showed no evidence of lymphadenopathy or other pathology. Radiographic examination demonstrated horizontal bone loss in the first and second molar region. Facial CT showed a 2.0 1.5-cm soft tissue mass on the lateral right maxilla near the second molar. The bony defect was found on the inferior-lateral wall of the right maxillary sinus. However, there was no change on the sinus mucosa (Fig 1B). After the patient was provided written informed consent, the incisional biopsy was performed to confirm clinical diagnosis of this gingival mass. Histopathologically, biopsy