Metastatic tumours to the oral region. An overview

Metastatic tumours to the oral region are uncommon. There are more published cases of jawbone métastases than in oral soft tissues. The most common primary sources of metastatic tumours to the oral region are the breast, lung, kidney, bone and colon. The breast is the most common primary site for tumours metastasising to the jawbones, whereas the lung is the most common source for métastases to the oral soft tissues. In the jawbones, the common location of the metastatic lesions is the mandible, with the molar area being the most frequent involved site. In the oral soft tissues, the attached gingiva is the most common affected site followed by the tongue. In nearly 30% of cases, the metastatic lesion in the oral region is the first indication of an undiscovered malignancy at a distant site. The biological basis of the metastatic process is discussed.     

转移性口腔肿瘤673例分析

口腔并非转移性肿瘤细胞定居的常见部位，但肿瘤远处转移至口腔则是其广泛转移的证据。在673例病例中，25％是肿瘤临床广泛转移的首发证据。23％的远处恶性肿瘤首先在口腔表现。颌骨，尤其是下颌骨较软组织更易受侵犯（2：1）。口腔附着龈是软组织最易受累及的部位（54％）。肿瘤是原发灶，男性为肺、肾、肝及前列腺，女性为乳腺、生殖器官、     

Metastatic tumours to the jaws and oral soft tissues: a retrospective analysis of 41 Korean patients

This article describes a pooled analysis of 41 Korean patients with metastatic oral tumours. The data reviewed are from Korean dental and medical case reports published between 1983 and 2004. The mean age was 55.2 years, and the male-to-female ratio was 1.9:1. There were more metastases in the jawbone than in oral soft tissues. The lung was the most common primary site for jawbone metastases, whereas the liver was for those of oral soft tissues. In contrast to reports in Western literature of the breast being the most common primary site, the liver was the most common primary site, followed by the lung and thyroid. These differences may be caused by a relatively high incidence rate of hepatocellular carcinoma in Korea.     

口腔颌面部炎症性肌纤维母细胞瘤8例临床分析

目的:探讨炎症性肌纤维母细胞瘤(IMT)在口腔颌面部的临床表现及治疗方法。方法:回顾总结2007—2011年期间诊治的8例颌面部IMT患者,分析其临床资料及治疗方法。结果:口腔颌面部炎症性肌纤维母细胞瘤肉眼观均为实性肿物,呈浸润性生长,与周围软组织黏连,无明显包膜。肿瘤镜检主要有梭形细胞型和黏液血管型2种组织学形态。除1例术后失访外,其余患者随访1～3a,情况稳定,未见局部复发或远处转移。结论:IMT是一种少见的间叶性肿瘤,多见于儿童和青壮年,罕见于头颈部,具有局部侵袭性和复发等低度恶性或交界瘤特点,远处转移少见;手术切除是口腔颌面部IMT首选的治疗方法。     

Metastatic tumors to the jawbones: analysis of 390 cases

A review of the English language literature revealed 390 well-documented cases of metastatic lesions to the jawbones. Most metastatic lesions were diagnosed in patients in their fifth to seventh decade. The primary site differed between the genders: for women, it was the breast followed by the adrenal, colorectum, female genital organs and thyroid; for men, it was the lung, followed by the prostate, kidney, bone and adrenal. The most common location of the metastatic tumors was the mandible, with the molar area the most frequent site involved. In about 30% of cases the oral lesion was the first sign of the malignant disease. The present data are compared with those of metastatic tumors to the oral mucosa and a view on the possible pathogenesis is presented.     

Metastatic tumors to the jaws and oral cavity.

Observations of the incidence of MT from distant organs and tissues to the maxillofacial region are presented on the basis of 13 cases (3.2% of the total number of patients with malignant tumors). Metastatic carcinomas are most frequently found in the mandible (61.5%). The primary locus is usually the breast, kidney, bronchus, or thyroid gland (61.5%), the diagnosis of metastasis aided in localization of the primary tumor. Successful results of radical treatment were obtained in only two cases; they survived for three and 11 years. The other 11 patients died within two months to a year. The function of maxillofacial surgeons in discovering primary and metastatic tumors of the jaws and face is emphasized.     

Extranodal non-Hodgkin's lymphoma of the oral tissues. An analysis of 20 cases

A series of 20 patients with extra-nodal non-Hodgkin's lymphoma (ENHL) of the oral cavity was analysed with the emphasis on histopathological variability and prognostic factors. The current diagnostic schemes as devised for nodal NHL proved also to be useful in diagnosing ENHL in the oral cavity. With respect to histopathology, intra-oral ENHL differs from nodal NHL in a lower incidence of nodular growth pattern and a relative predominance of the lymphoma sub-type with large vesicular indented nuclei. These are features, however, that are shared with ENHL in other body sites and thus are not unique to the oral location. Another salient histological feature was the presence of proliferating bizarre spindle cells with formation of whorling bundles of reticulin, thus creating a pseudosarcomatous growth pattern in some cases. The clinical stage proved to be the main discriminating factor between those who survived and those who died of their lymphoma. Of the patients who were in stage IE on admission, 70% survived as opposed to only 20% of those who were in stage II or IV. A better prognosis for cases with soft tissue involvement as opposed to intraosseous lymphoma is probably due to a consistently lower clinical stage in the former group. The prognostic value of the clinical stage emphasizes the importance of adequate clinical staging procedures.     

口腔颌面部结节性筋膜炎临床病理分析（附3例报告）

目的：分析口腔颌面部结节性筋膜炎的临床病理特点,方法：对3例结节性筋膜炎性HE及免疫组化SP法染色和组织学观察,结果：3例结节性膜断断续续的为病史短,生长快,中年女性多见,发病部位为颊、舌、磨牙后区,肿物呈结节性,无包膜,直径在3cm以内,质偏硬,组织学特点为纤维母细胞增生活跃,核分裂象易见,“S”形结构,组织裂隙,外渗红细胞,粘液背是,Vim( ),SMA( ),Des(-).结论：结节性筋膜炎的本质是纤维母细胞和肌纤维母细胞增生,其组织学构型有诊断价值,需注意与肉瘤的鉴别诊断。     

Metastatic carcinoma to the oral tissues and jaws: a study of 25 cases

In a series of 2,409 oral and jaw malignant tumors, 25 are metastatic account for 1% of malignant tumors in these regions. The commonest sites of the primary tumors were uterus and thyroid (5 cases each), followed by lung and liver (4 cases each), breast and stomach (2 cases each), femur, kidney and esophagus (1 case each) Among 25 cases, 13 occurred in oral soft tissues (12 in gingiva and 1 lip) and 12 in the jaws Alterations in sensation of the lip was the commonest oral symptoms when the metastatic tumors occurred in the mandible. On the radiograms, osteolytic destruction (9/12) was more common than osteogenic (2/12) or cyst-like change (1/12). In the patients with metastatic tumor of oral soft tissues, the bone may be unchanged (4/10), or involved similar to those in carcinoma of gingiva (4/10) or periodontal diseases (2/10).     

Primary extranodal non-Hodgkin lymphoma of the oral cavity. An analysis of 34 cases

34 patients with primary extranodal non-Hodgkin lymphoma (PE-NHL) of the oral cavity have been studied with reference to age, sex, clinical symptoms, location of primary tumour, histological subtype, grade of malignancy according to the Working Formulation, stage of disease, treatment and follow-up. The clinicopathological features of these oral PE-NHL correspond with those of PE-NHL in general. Survival was influenced by stage of disease and grade of malignancy.     

Metastatic tumours to the oral cavity: a survival study with a special focus on gingival metastases

Aims: To describe survival from oral metastases, particularly gingival metastases, and to identify clinical prognostic variables.
Materials and Methods: A series of 39 patients were studied, analysing age, gender, primary tumour site, oral metastases site and histological type.
Results: Mean age: 62.3±9.2 years, with similar prevalence by gender. The most frequent sites for primary tumours were the kidney (20.5%), lung (20.5%) and breast (20.5%). Gingival metastases represented 63.6% of all oral soft tissue metastases (7/11). The average time between primary tumour diagnosis and appearance of the gingival metastases was 9.7±13.4 months. The median survival time since gingival metastases appearance was 5.2 months [95% confidence interval (CI)=0–13.6]; no statistically significant difference with other oral locations was found by the Kaplan–Meier curves (log rank: 0.29; p >0.05). Oral metastases involving the gingiva were more frequently found in the maxilla (85.7% versus 14.3%), whereas intra-osseous metastatic tumours were more frequent in the mandible (77.8% versus 22.2%; p <0.05; odds ratio=21; 95% CI=2.0–210.1). None of the variables considered had a prognostic value as indicated by the Kaplan–Meier test.
Practical implications: The data in this paper show that 25% (and in other studies up to 37%) of oral metastases came from unknown primary tumours; thus a biopsy with histopathologic analysis is mandatory for every patient with a gingival mass.
Conclusions: This study reinforces the significance of gingival metastases as a poor prognosis indicator. Dental practitioners should suspect that gingival masses mimicking benign or inflammatory lesions may represent a sign of underlying malignant tumours.     

An epidemiologic study of oral clefts in Iran: analysis of 1,669 cases.

OBJECTIVE: The objective of this study was to assess the epidemiology and some genetic aspects of oral clefting in Iran. DESIGN: The study was a 15-year cross-sectional (prevalence) study from August 1976 to September 1991. SETTING: The setting for the study was two plastic surgery departments, both mostly referral centers, and a maternity hospital in Iran. PARTICIPANTS: The participants were 1,669 consecutive surgical cases with oral clefts (79% between 1 day and 18 months of age), registered in two centers. In a parallel study, 19,369 livebirths born in a maternity hospital within the same period were surveyed to ascertain prevalence of clefting at birth. Normal children of this population were used as the control group. Samples were analyzed by prevalence of clefting at birth, type of oral cleft, side of clefting, sex ratio, associated malformations, clefts in relatives, and parental consanguinity. RESULTS: The prevalence of clefts was 1.03 per 1,000 births. Cleft lip (without cleft palate) had a higher (34.9%) and cleft palate alone had a significantly lower prevalence (17.4%) than expected. Cleft lip (without cleft palate) was more common in females (53.6%) than in males (46.4%). The rate of associated malformations in cleft patients (7.73%) was higher than in controls (0.093%). Association between clefting and consanguinity was significant (45.8% in cases versus 43.1% in controls). Occurrence of noncleft congenital malformations among first-degree relatives of our cases (2.77%) was nearly two times that of controls (1.55%). CONCLUSION: Our study reveals that the population incidence of oral clefts in Iran is much closer to European than Arab-African or South East Asian countries. However, significant variations in other epidemiologic and some genetic features were observed.     

Melanoma of the oral mucosa. Clinical cases and review of the literature

The appearance of primary melanomas of the oral mucosa is uncommon. The aggressiveness of this entity and the absence of any standardized treatment protocol make the prognostic unfortunate. The difficulty to obtain free surgical margins, the elevated tendency to invade in depth and the early haematogenous metastasis have been referred as features which may explain its bad prognosis, even in comparison with cutaneous melanoma. However, no large clinical series exist and actually, clinical cases are the main source of information. Due to the absence of any treatment modality which may substantially increase long-term survival, we suggest the use of resective surgery with wide margins and early diagnosis by means of biopsy for suspicious melanotic-pigmented lesions. In this work we present 2 new cases of primary melanoma of the oral mucosa, with a follow-up period of 72 and 12 months respectively, and we make a review of the literature in relation with this rare entity.     

Optimization of preoperative chemotherapy by ultrasound. Follow-up in tumours of the oral cavity and oropharyngeal region

The results in 53 patients with tumours of the oral cavity and oropharyngeal region who received Cisplatinum/5-FU indicate that ultrasound monitoring of preoperative antineoplastic chemotherapy is a valuable, effective, and economical/imaging method which improves the early adjustment of the therapy concept to response rates at the C2-level.