Two cases of metastatic adenocarcinoma occurring in the oral cavity are presented. One patient experienced lip paresthesias and pain as the presenting complaint. The other patient developed a growth at the site of a recent tooth extraction, and had bony erosion of the adjacent maxilla. The literature on metastatic lesions to the oral cavity including mandible is reviewed. This problem has been described almost exclusively in the oral and dental surgery literature. The clinical symptoms and signs described here should suggest the possibility of metastatic tumor to the oral cavity, and may be the initial manifestation of malignant disease.
Cancer 54:lllO-1112, 1984.
ISTANT METASTATIC DISEASE occurs at initial pre-
D sentation in about one third of patients with adenocarcinoma of the rectum. The most common sites of metastatic spread are liver (83%), lung (15%), and bone (5.9%).1*2 In working up patients with rectal cancer for metastatic disease, distal bones are seldom implicated as sites of metastatic deposits. Similarly the mandible is not included in such a workup, and may be involved more often than previously appreciated. We wish to report two unusual cases of metastatic adenocarcinoma of the rectum, one presenting as pericoronitis of the third mandibular molar, and the other as a gingival lesion following tooth extraction.
Case Reports
Case 1
A 45-year-old white woman presented in January 1980 with diarrhea, increasing rectal pressure, and decreased stool caliber. A clinically palpable ulcerated rectal lesion was found. During abdominoperitoneal resection a small tumor of the distal rectum was removed along with generous amounts of perirectal soft tissue and lymph nodes. Microscopic examination revealed a moderately well-differentiated adenocarcinoma extending through the muscle wall into the penrectal tissue. Seven perirectal lymph nodes were removed and were replaced by tumor (Dukes Stage C2), and venous invasion was present.