牙龈转移性腺癌2例及文献复习

目的 :探讨牙龈转移性癌的临床特点和诊断标准。方法 :对 2例牙龈转移性腺癌的报道 ,结合对国内外 49例文献报道的复习。结果 :牙龈转移性癌临床上易于血管性龈瘤、周边性巨细胞肉芽肿、肉芽肿性龈瘤和纤维性龈瘤相混淆 ,但有其独特性。结论 :牙龈转移性癌的预后较差 ,故及时发现、诊断和治疗 ,有助于提高患者的生存质量和生存率。     

食管基底细胞样鳞状细胞癌转移至牙龈

肿瘤转移至口腔,尤其是口腔软组织极为少见。本文报道1例。 患者为63岁男性,曾患晚期食管癌并行姑息性食管切除术。来口腔门诊要求鉴定牙龈上逐渐增大的肿物。口腔检查见:下颌磨牙区舌侧牙龈上一突出的2cm×1.8cm大小的肉芽性出血肿物,有蒂,未发现其它部位损害及淋巴结肿大,未有溶骨性损害,未见远距离癌肿组织转移。切除后的食管癌诊断为基底细胞样鳞状细胞癌。切除的牙龈肿物主要为包含小基底细胞的未分化癌肿和鳞状成分。非常类似食管癌的组织学特征,进一步的免疫组织化学染色(抗生物素蛋白—生物素复合染色技术)确诊为食管基底细胞样鳞状细胞     

口腔转移癌(腺癌)2例及文献复习

口腔转移癌较少,据Meyer报告占口腔恶性肿瘤的1％。在口腔转移癌中50％以上是腺癌,且以转移到颌骨的较软组织为多。作者将两例转移癌的经过,结合近年来报告的文献作了讨论病例1,女性,59岁。1975年8月因食欲不振求诊,经详细检查无结果,同年10月出现食物通过障碍,呕吐而再次求诊。于1976年1月经纤维胃镜诊断为胃癌,两个月后行手术包括切除食道、贲门及作再建术。经过良好。据术中及组织病理学所见诊断为P_0H_N_2S_3第四期腺癌。既往史及口腔所见:于1976年2月发现1区牙龈肿胀,不久缩小未作处理。同年5月该区龈再次出现龈瘤状无痛性肿大,因有增大倾向,检查见1的近中到13的近中,以12区为中心的牙龈上形成拇指大、有     

睑板腺癌腮腺及下颌下区颈淋巴结转移1例报告

睑板腺癌常发生于上眼睑,转移至腮腺及下颌下淋巴结者较为少见,临床上需与腮腺原发肿瘤相鉴别。本文报告1例上眼睑睑板腺癌转移至腮腺及下颌下区淋巴结病例,为此类疾病的诊断及治疗提供指导。     

口腔粘膜淀粉样变一例报道

口腔粘膜多发性淀粉样变在临床上较为少见。现报道如下：患者，男，58岁。主诉：口腔肿物二月余。病史：两个月前发现舌、颊部长肿物，逐渐增大，无溃烂及出血，无疼痛及搔痒感。8个月前因面色苍白在当地县医院诊断为“贫血”，经用各种药物治疗和牌切除、胃大部分切除等治疗，均无好转。否认家族中类似病史。患者因“贫血原因待查”，而收住广西医科大学第一附属医院血液科病房。因口腔肿物在我科门科就诊。口内检查：两侧舌缘、两颊粘膜中部、上下唇粘膜见成片高出粘膜表面的结节，其表面有的呈石榴状小结节，有的呈半球形、圆锥形或多角…     

口腔转移癌2例临床病理分析及文献复习

目的:分析口腔转移性肿瘤的临床病理特点、治疗及预后。方法:对2例口腔转移性肿瘤的临床病理形态分析,辅以免疫组织化学染色,并结合文献复习。结果:2例口腔转移性肿瘤,1例原发肿瘤为肝内胆管腺癌,另1例原发肿瘤为肝细胞肝癌,转移性肿瘤形态与原发部位肿瘤较一致,必要时可辅以免疫组织化学染色。结论:口腔转移性肿瘤少见,明确诊断最终依赖病理学检查,但详细了解病史对明确诊断有重要意义。     

口腔疣状癌的临床生物学行为及治疗（附病例报道）

口腔疣状癌为临床少见的恶性肿痛，好发于颊黏膜或牙龈，发生于口唇者甚少，早期无特征性临床农现，晚期可侵犯周围组织，出现唇、颊、颌骨等组织缺损，也可出现颈部淋巴结转移，远处转移少见，生物学行为呈多样性，低度恶性，预后不确定等特点。     

直肠腺癌转移至牙龈1例报告及文献复习

直肠腺癌转移至牙龈非常罕见。本文报道1例81岁女性患者,结肠癌切除2年后出现直肠腺癌,并转移至牙龈。通过组织病理学检查、免疫组织化学染色确诊。口腔转移很少发生,并且通常易被误诊为更常见的良性病变,因此应将其视为鉴别诊断中的一种可能性。完善的临床检查以及多学科诊疗非常必要。     

腭部多形性低度恶性腺癌伴颈淋巴结及全身多处广泛转移:1例报告及文献复习

多形性低度恶性腺癌是一种少见的唾液腺肿瘤,局部转移率低,全身转移更为罕见,预后良好.本文报告1例腭部多形性低度恶性腺癌伴颈淋巴结及全身多处广泛转移病例,并结合有关文献,对其临床表现、病例特征、鉴别诊断、治疗及预后等进行讨论.     

��ǻ�Ĥԭ�����Ժ�ɫ�������ٴ��Ͳ���

提要：口腔黏膜原发恶性黑色素瘤是一种少见的恶性肿瘤,具有易复发、易转移、预后较差的特点。由于病例数稀少,临床及随访资料匮乏,并且缺少通行的黏膜恶性黑色素瘤分期分级标准。因此,对口腔黏膜原发恶性黑色素瘤还缺乏全面深入的认识。本文通过回顾相关文献,从流行病学、临床、病理、诊断和鉴别诊断以及分类等方面来概述口腔黏膜原发恶性黑色素瘤的特点。     

Gingival metastasis of a bronchogenic adenocarcinoma: report of a case

We report the case of a 64-year-old patient suffering from a multiple metastatic bronchial adenocarcinoma, referred to our department for a gingival tumefaction. The diagnostic assumptions considered were those of a pyogenic granuloma, of a primary gingival carcinoma, or of a metastasis of the bronchial tumor. An excisional biopsy was carried out and the histopathologic examination confirmed the latter diagnosis. No complementary care was performed because of the multiple localizations and unfavorable prognosis. If metastases of pulmonary cancers represent the majority of gingival metastases, those of bronchial adenocarcinoma are very rare. Metastatic process could be facilitated by Batson's plexus, through the periodontal inflammation or the direct bronchotracheal way. The main clinical diagnostic difficulty is the distinction between benign lesion and malignant lesion, and between primary lesion and metastasis. Even if gingival metastases are rare, their semiological value incites the histopathologic examination of any presumedly benign tumor of the gingiva.     

Gingival metastasis from salivary duct carcinoma of the parotid gland

BACKGROUND: This article reports a rare case of metastasis of salivary duct carcinoma of the parotid gland to the gingiva and reviews the occurrence of metastatic processes to the oral mucosa. METHODS: A 67-year-old white male presented with a chief complaint of a painless nodular tissue growth on the gingiva with reportedly 5 months of evolution. The intraoral examination revealed a reddish, superficially ulcerated nodular lesion ( approximately 2 cm in diameter) on the right mandibular buccal attached gingiva, and the clinical aspect was that of a benign reactive lesion. The patient had undergone a parotidectomy for removal of a salivary duct carcinoma of the parotid gland almost 1 year before. A biopsy of the gingival lesion was performed, and the biopsied tissue was forwarded for histopathologic examination. RESULTS: The analysis of the histopathologic sections of the gingival lesion revealed histomorphologic characteristics very similar to those of the primary parotid gland tumor. The definitive diagnosis was gingival metastasis from a salivary duct carcinoma of the parotid gland. The patient died of complications of a pulmonary metastasis 1 month after the diagnosis of the oral metastatic lesion. CONCLUSIONS: Gingival lesions that mimic reactive and hyperplastic lesions may be metastases from malignant neoplasias of diverse origins. An accurate and timely diagnosis is crucial to establish proper and immediate treatment of the metastatic tumor and possibly identify an occult primary malignant neoplasia.     

Exophytic mass of the gingiva as the first manifestation of metastatic pulmonary adenocarcinoma

BACKGROUND: Metastasis of a malignant tumor to the oral cavity is rare, but it can be the first manifestation of a primary tumor. METHODS: The clinicopathologic features of a gingival metastasis originating from lung adenocarcinoma in a female patient are described. A 57-year-old woman showed a rapidly growing, painless, exophytic mass in the left mandibular gingiva. The whole lesion was excised, and histologic and immunohistochemical analyses were performed. RESULTS: The histopathologic sections showed a proliferation of poorly differentiated spindle and pleomorphic cells. Because the differentiation between carcinoma and sarcoma of spindle cell tumors was difficult, additional immunohistochemical evaluation was performed. The intraoral healing after tumor removal was uneventful. The discrepancy between the histopathologic results and the clinical findings led to a thorough examination by the patient's physician. Finally, a biopsy of the lungs confirmed a poorly differentiated adenocarcinoma with multiple metastases, including the oral cavity. CONCLUSIONS: An exophytic lesion on the gingiva can be the first sign of metastatic adenocarcinoma to the oral mucosa. This case emphasizes that even apparently benign-looking gingival lesions in anamnestically healthy patients need to be examined histopathologically.     

Initial presentation of lung sarcomatoid carcinoma as a metastatic lesion in the mandibular gingiva

BACKGROUND: Sarcomatoid carcinoma of the lung is a very rare type of tumor characterized by distant metastasis. However, metastasis to the gingiva is an uncommon event. Occasionally, an oral metastatic lesion may be the preliminary clinical feature observed before the diagnosis of the primary tumor. METHODS: The clinical features of gingival metastasis as an initial presentation of lung sarcomatoid carcinoma are discussed. A 55-year-old male patient presented with a rapidly growing pedunculated exophytic mass on the gingiva at the left side of the lower jaw. Incisional biopsy was performed. RESULTS: The histologic and immunohistochemical diagnosis was metastatic carcinoma. To locate the primary tumor, we analyzed the lung lesion by chest computerized tomography (CT) scans and biopsy. The patient was ultimately diagnosed with sarcomatoid carcinoma of the lung with gingival metastasis. Palliative chemotherapy for lung cancer was administered. The gingival lesion disappeared after chemotherapy. CONCLUSION: Although this case is unusual, periodontists should recognize that gingival masses similar to benign or inflammatory lesions may represent an initial sign of underlying malignant tumors.     

Large cell carcinoma of the lung metastatic to the mandibular gingiva

BACKGROUND: Although metastases of malignant tumors to the jaws are not unusual, metastases to the gingival soft tissues are relatively rare. METHODS: The clinicopathologic features of a metastatic tumor in the mandibular gingiva originating from lung cancer are described. The patient, a 61-year-old man, was admitted to the hospital with complaints of bloody sputum and chest pain while coughing. The patient's chest radiograph showed an abnormal mass in the left upper lobe. After admission, the patient noticed a swelling of the right mandibular gingiva. Histological and immunohistochemical analysis for tumors of the gingiva and the lung were performed. RESULTS: Radiographic examination did not indicate involvement of the underlying bone. The histopathological findings showed that the gingival tumor consisted of a large cell carcinoma, and the mass of the upper lobe displayed the same histology as that found in the gingiva. Immunohistochemical investigation of the gingival tumor revealed similar results to those found in the mass of the lung. Based on the clinicopathologic findings, this case was diagnosed as primary lung cancer with the gingival tumor deemed metastatic. Multiple metastases were found in areas other than the oral cavity; radiation and chemotherapy for the gingival tumor were performed due to persistent bleeding and pain. CONCLUSIONS: The resemblance of this gingival mass to an inflammatory lesion demonstrates the need for a detailed examination. This case also emphasizes the need to evaluate positive treatment needed to relieve complications in the mouth, even if the prognosis of the primary tumors remains unfavorable.     

Undifferentiated malignant neoplasm involving the interdental gingiva: a case report

BACKGROUND: Metastases to the gingiva are uncommon. They can be a diagnostic challenge clinically because of their rarity and tendency to mimic benign lesions. In this report, we present a case of an undifferentiated malignant neoplasm of unknown origin presenting as benign inflammatory gingival lesions and we review the literature on metastases to the gingiva. METHODS: A 44-year-old female patient was referred by a local periodontist for evaluation of multiple painless gingival lesions that clinically resembled pyogenic granulomas or periodontal abscesses, but with an uncharacteristic multifocal presentation in the background of good oral hygiene. Her medical history was unremarkable except for recent weight loss. Periapical radiographs were obtained, as well as two incisional biopsies, one placed in formalin for routine histology and immunohistochemistry, the other in phosphate buffered saline for flow cytometry. RESULTS: Radiographic findings were non-contributory for hard tissue pathoses. Histopathological findings were consistent with a poorly differentiated malignancy, suggestive of metastatic disease. Immunohistochemical studies and flow cytometry were unsupportive in delineating any tumor differentiation. The patient subsequently developed multiple tumors throughout the body with similar histopathological findings, yet no primary tumor was identified and a definitive diagnosis could not be rendered. She was discharged one month later in poor condition with the principal diagnosis of hemorrhage/ pancytopenia, and a secondary diagnosis of metastatic head and neck cancer. CONCLUSION: This case of malignant metastatic tumor of unknown origin presenting as benign gingival lesions illustrates the importance of thorough patient evaluation, which should include a biopsy when necessary for definitive diagnosis.     

Colonic adenocarcinoma with metastasis to the gingiva

Metastatic tumors involve the oral cavity, and the most common primary sites are the breast and lung. Most cases affect the mandible and maxilla in that order, although some of them can be located in the soft perioral tissues. We report the case of a 62-year-old male who had been diagnosed with sigmoid adenocarcinoma with nodal and liver metastasis, who presented 6 months later with a gingival polypoid tumor, at first considered as a primary neoplasm of gingiva, that was diagnosed in a biopsy as metastatic intestinal adenocarcinoma. The histological evaluation is essential to separate adenocarcinoma from the commoner in this site squamous cell carcinoma, and the immunohistochemical techniques are useful to distinguish metastatic tumor versus primary adenocarcinoma from the minor salivary glands of the area. The intraoral spread of a disseminated neoplasm is generally a sign of bad prognosis, although a longer survival can be expected if a radical surgical treatment of a solitary metastasis is carried out.     

Hepatocellular Carcinoma Metastatic to the Gingiva as a First Manifestation of Hepatocellular Carcinoma

A 55-year-old man consulted to our hospital complaining of a gingival tumor. Oral examination showed granulation tissue-like polypoid tumors (2 × 2 × 1 cm) in the left upper gingiva. A clinical diagnosis of granulation tissue was made, and an incisional biopsy was performed. It showed carcinoma cells in the submucosa. They were arranged in compact and sinusoidal patterns. A few bile plugs and one Mallory-like body were recognized by meticulous examination. An immunohistochemical study showed that the tumor cells were positive for hepatocyte paraffin-1 (HepPar-1), cytokeratins (AE1/3 and CAM6.2), and p53 protein. The carcinoma cells were negative for vimentin, prostate specific antigen, CD10, and α-fetoprotein. The Ki-67 labeling was 49%. A histological diagnosis of hepatocellular carcinoma (HCC) metastatic to the gingiva was made. Then, the patient was referred to hepatology unit. A blood laboratory test showed elevated elevated liver enzymes, and positive antibody to hepatitis C virus. Liver cirrhosis was also present. Imaging modalities including US, CT, and MRI revealed multiple hepatic tumors. Metastases to other sides were not recognized. The patient was diagnosed as cirrhosis and HCC with an extrahepatic metastasis to the gingiva. The patient was now treated by chemotherapy. The present case shows that HCC can manifest as small gingival tumors, and meticulous HE examination and immunoreactive HepPar-1 are useful in the diagnosis of HCC in extrahepatic metastatic sites.     

Isolated gingival metastasis from hepatocellular carcinoma mimicking a pyogenic granuloma

BACKGROUND: Oral metastatic tumours are uncommon and account for approximately 1% of malignant oral neoplasms. RESULTS: If the cases where the oral location is in the jawbone, with secondary invasion to the oral soft tissue, are excluded, only 10 cases of gingival metastasis from hepatocellular carcinoma (HCC) have been previously reported in the literature. The clinicopathologic features of an HCC with gingival metastasis are reported. Six months after the multicentric HCC and alcoholic cirrhosis was diagnosed, a 65-year-old male patient presented a rapidly growing, lobulated and reddish exophytic lesion that was located in the gum in the incisal region of the upper jaw. The lesion was excised, and the final diagnosis of gingival metastasis of the HCC was established. Diagnostic investigations did not show any evidence of other metastatic lesions. This article describes a case with solitary metastasis from HCC in the gingiva, an event that, to our knowledge, has not been previously published. CONCLUSIONS: The clinical appearance of isolated gingival metastasis from HCC in the present case mimicked a pyogenic granuloma.