Clinicopathological study of 13 cases of intraoral soft tissue metastatic carcinomas

Abstract

Background/purpose: Oral metastatic carcinomas are rarely found in oral soft tissues. This study reported the clinicopathological features of 13 intraoral soft tissue metastatic carcinomas.

Materials and methods: A total of 13 intraoral soft tissue metastatic carcinomas were included in this study. The clinicopathological features of the 13 cases including the primary cancer site, metastatic intraoral soft tissue region, clinical presentation, and histopathological diagnoses were examined and reported.

Results: The 13 intraoral soft tissue metastatic carcinomas occurred in 13 patients (11 males and 2 females) with a mean age of 59.4 (range, 39-78) years. Nine cases originated from the liver (69.2%), and one each from the colon (7.7%), pancreas (7.7%), thyroid (7.7%), and kidney (7.7%). The histopathological diagnoses of the metastatic lesions were hepatocellular carcinoma in 9 cases, adenocarcinomas in 2 cases (one each from the colon and pancreas), clear cell carcinoma of the kidney in one case, and follicular thyroid carcinoma in one case. The gingiva and alveolar mucosa were the major metastatic sites (10 cases, 76.9%), followed by the buccal mucosa (two cases, 15.4%), and soft palate (one case, 7.7%). Twelve metastatic lesions manifested as ulcerated, easy-bleeding, and pyogenic granuloma-like lesions.

Conclusion: The results of our series of 13 cases indicate that intraoral soft tissue metastatic carcinomas have a male predilection with a male to female ratio of 11:2, are commonly found in the gingiva and alveolar mucosa (76.9%), present frequently as an easy-bleeding pyogenic granuloma-like lesion (92.3%). In addition, the most common primary cancer site is the liver.

Keywords: Oral metastatic carcinoma; Oral soft tissue.

Figure 1

Clinical, radiographic, and microscopic photographs of case 8, a primary hepatocellular carcinoma with metastasis to the gingiva. (A) An exophytic, partially ulcerated mass at the buccal gingiva of teeth 43 to 45. (B) Panoramic radiography revealed no bony destruction at the mandibular body between teeth 43 and 45. (C) The metastatic carcinoma composed of islands of hyperchromatic and pleomorphic tumor cells (hematoxylin and eosin stain; magnification, 200×). (D, E and F) The tumor cells were positive for CK7 (D, magnification, 100×), negative for CK20 (E, magnification, 100×), and positive for HepaPar1 (F, magnification, 100×). (G) Microscopic features of the gingival metastatic lesion are consistent with a primary hepatocellular carcinoma (magnification, 100×).