Case Report/Clinical Techniques| Volume 37, ISSUE 1, P110-113, January 2011

Mucinous Adenocarcinoma of Lung Presenting as Oral Metastases: A Case Report and Literature Review



      Metastasis of a malignant tumor to the oral cavity is rare and can indicate an unknown primary tumor.


      Described is a case of metastatic tumor in the right jaw. The patient was a 50-year-old woman who consulted her dentist with complaints of tooth pain and an abscess. The clinical examination showed an abscess around the mandibular right first molar and second premolar tooth. Teeth were extracted and two periapical, nontypical cystic lesions were excised.


      The histopathological analysis revealed mucinous malignant cells embedded in an inflammatory infiltration and fibrinous tissue. The diagnosis was metastatic mucinous adenocarcinoma. The lesion at the apex of teeth was the initial presenting site of the patient’s lung cancer. There was no other site of metastasis.


      There are typical dental apical cysts that do not usually require a histopathological examination, but mucinous and nontypical cysts must be sent for a histopathological examination. The case emphasizes the important role of dentists in diagnosing metastatic oral lesions and shows that even apparently benign atypical lesions in healthy patients need to be examined histopathogically.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Barr C.E.
        • Dym H.
        • Weingarten L.A.
        Metastatic mucous-producing adenocarcinoma of the gingiva.
        J Am Dent Assoc. 1980; 101: 53-54
        • Dib L.L.
        • Soares A.L.
        • Sandoval R.L.
        • et al.
        Breast metastasis around dental implants: a case report.
        Clin İmplant Dent Relat Res. 2007; 9: 112-115
        • Tseng L.N.
        • Berends F.J.
        • Wittich P.
        • et al.
        Port-site metastases. Impact of local tissue trauma and gas leakage.
        Surg Endosc. 1998; 12: 1377-1380
        • Hirshberg A.
        • Leibovich P.
        • Horowitz I.
        • et al.
        Metastatic tumors to post extraction sites.
        J Oral Maxillofac Surg. 1993; 51: 1334-1337
        • Snyder M.B.
        • Cawson R.A.
        Jaw and pulpal metastasis of an adrenal neuroblastoma.
        Oral Surg Oral Med Oral Pathol. 1975; 40: 775-784
        • Milobsky S.A.
        • Milobsky L.
        • Epstein L.I.
        Metastatic renal adenocarcinoma presenting as periapical pathosis in the maxilla.
        Oral Surg Oral Med Oral Pathol. 1975; 39: 30-33
        • Pliskin M.E.
        • Mastrangelo M.J.
        • Brown A.M.
        • et al.
        Metastatic melanoma of the maxilla presenting as a gingival swelling.
        Oral Surg Oral Med Oral Pathol. 1976; 41: 101-104
        • Pastremoli A.
        Gingival metastasis, the first clinical sign of a silent kidney carcinoma. A case report.
        Minerva Stomatol. 1991; 40 ([in Italian]): 825-828
        • Rass T.
        • Prein J.
        Differential diagnosis of epulis-type changes in the mouth.
        Swiss Dent. 1992; 13: 21-27
        • Peris K.
        • Cerroni L.
        • Paoloni M.
        • et al.
        Gingival metastasis as first sign of an undifferentiated carcinoma of the lung.
        J Dermatol Surg Oncol. 1994; 20: 407-409
        • Alandez J.
        • Llanes F.
        • Herrera J.I.
        • et al.
        Metastatic lung carcinoma involving the periodontium. Report of a case.
        J Periodontol. 1995; 66: 896-898
        • Miyatake K.
        • Ueoka H.
        • Tabata M.
        • et al.
        Gingival metastasis of large-cell lung cancer that produced G-CSF.
        Nihon Kyobu Shikkan Gakkai Zasshi. 1995; 33 ([in Japanese]): 1283-1287
        • Llanes F.
        • Sanz-Ortega J.
        • Suarez B.
        • et al.
        Hepatocellular carcinomas diagnosed following metastasis to the oral cavity. Report of 2 cases.
        J Periodontol. 1996; 67: 717-719
        • Santamaria J.
        • Garcia A.M.
        • Gil J.
        • et al.
        Metastasis of a malignant melanoma to the region of an impacted mandibular third molar. A case report.
        J Oral Maxillofac Surg. 1997; 55: 1003-1006
        • Srinivasan S.V.
        • Pal K.M.
        • Dayal P.K.
        • et al.
        Metastatic malignant melanoma of maxillary gingiva. A case report.
        Indian J Dent Res. 1997; 8: 119-122
        • Rajesh K.S.
        • Varma B.R.
        • Bhat K.M.
        Metastasis to maxillary gingiva from carcinoma of breast. A case report.
        Indian J Dent Res. 1998; 9: 23-27
        • Chin A.
        • Liang T.S.
        • Borislow A.J.
        Initial presentation of hepatocellular carcinoma as a mandibular mass: case report and review of the literature.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 86: 457-460
        • Piattelli A.
        • Fioroni M.
        • Rubini C.
        Gingival metastasis from a prostate adenocarcinoma: report of a case.
        J Periodontol. 1999; 70: 441-444
        • Piattelli A.
        • Fioroni M.
        • Rubini C.
        Gingival metastasis from a medullary thyroid carcinoma: case report.
        J Periodontol. 2000; 71: 112-116
        • Maiorano E.
        • Piattelli A.
        • Favia G.
        Hepatocellular carcinoma metastatic to the oral mucosa: report of a case with multiple gingival localizations.
        J Periodontol. 2000; 71: 641-645
        • Watanabe M.
        • Yasuda K.
        • Tomita K.
        • et al.
        Lung cancer metastasis to the gingiva.
        Nihon Kokyuki Gakkai Zasshi. 2001; 39 ([in Japanese]): 50-54
        • de Courten A.
        • Irle C.
        • Samson J.
        • et al.
        Metastatic transitional cell carcinoma of the urinary bladder presenting as a mandibular gingival swelling.
        J Periodontol. 2001; 72: 688-690
        • Scipio J.E.
        • Murti P.R.
        • Al-Bayaty H.F.
        • et al.
        Metastasis of breast carcinoma to mandibular gingiva.
        Oral Oncol. 2001; 37: 393-396
        • Ahmad S.
        • Roberts G.J.
        • Lucas V.S.
        • et al.
        Metastatic infiltration of the dental pulp by medulloblastoma.
        J Oral Pathol Med. 2002; 31: 244-245
        • Yoshii T.
        • Muraoka S.
        • Sano N.
        • et al.
        Large cell carcinoma of the lung metastatic to the mandibular gingiva.
        J Periodontol. 2002; 73: 571-574
        • Tanaka M.
        • Hiraki A.
        • Ueoka H.
        • et al.
        Gingival metastasis in lung cancer.
        Oncol Rep. 2002; 9: 571-574
        • Ramón Ramirez J.
        • Seoane J.
        • Montero J.
        • et al.
        Isolated gingival metastasis from hepatocellular carcinoma mimicking a pyogenic granuloma.
        J Clin Periodontol. 2003; 30: 926-929
        • Aoe K.
        • Hiraki A.
        • Kohara H.
        • et al.
        Gingival metastasis as initial presentation of small cell carcinoma of the lung.
        Anticancer Res. 2003; 23: 4187-4189
        • Elkhoury J.
        • Cacchillo D.A.
        • Tatakis D.N.
        • et al.
        Undifferentiated malignant neoplasm involving the interdental gingiva: a case report.
        J Periodontol. 2004; 75: 1295-1299
        • Scipio J.E.
        • Murti P.R.
        • AlBayaty H.F.
        • et al.
        Metastasis of breast carcinoma to mandibular gingiva.
        Oral Oncol. 2001; 37: 393-396
        • Kao S.Y.
        • Tu H.F.
        • Chang K.W.
        • et al.
        Epithelioid sarcoma metastasis to the gingivae: a case report.
        Int J Oral Maxillofac Surg. 2004; 33: 205-208
        • Stefani M.
        • Angiero F.
        Dental pulp metastasis from oral squamous cell carcinoma: a case report and a review of the literature.
        Pathologica. 2006; 98 ([in Italian]): 48-52
        • Suárez Roa Mde L.
        • Ruiz Godoy Rivera L.M.
        • et al.
        Breast malignant phyllodes tumour metastasising to soft tissues of oral cavity.
        Clin Transl Oncol. 2007; 9: 258-261
        • Curien R.
        • Moizan H.
        • Gerard E.
        Gingival metastasis of a bronchogenic adenocarcinoma: report of a case.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104: e25-e28
        • Pozzi E.C.
        • Altermatt H.J.
        • Rees T.D.
        • et al.
        Exophytic mass of the gingiva as the first manifestation of metastatic pulmonary adenocarcinoma.
        J Periodontol. 2008; 79: 187-191
        • Gambhir S.S.
        • Czernin J.
        • Schwimmer J.
        • et al.
        A tabulated summary of the FDG PET literature.
        J Nucl Med. 2001; 42 (1S–93)
        • Lonneux M.
        • Reffad A.
        Metastases from unknown primary tumor: PET-FDG as initial diagnostic procedure?.
        Clin Positron Imaging. 2000; 3: 137-141
        • Bohuslavizki K.H.
        • Klutmann S.
        • Kroger S.
        • et al.
        FDG PET detection of unknown primary tumors.
        J Nucl Med. 2000; 41: 816-822
        • Kole A.C.
        • Nieweg O.E.
        • Pruim J.
        • et al.
        Detection of unknown occult primary tumors using positron emission tomography.
        Cancer. 1998; 82: 1160-1166
        • Rades D.
        • Kuhnel G.
        • Wildfang I.
        • et al.
        Localized disease in cancer of unknown primary (CUP): the value of positron emission tomography (PET) for individual therapeutic management.
        Ann Oncol. 2001; 12: 1605-1609