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      • Record: found
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      Huge maxillary metastasis of an aggressive Pancoast tumor –A case report

      case-report

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          Abstract

          Background:

          Metastatic carcinomas to the upper jaw region are very rare and unfortunately occur in advanced stages of malignancies. Pancoast tumor is a challenging subset of lung carcinoma commonly followed by distant metastasis. Since the metastatic lesion of our patient was very huge and unusual, we decided to report the case.

          Case Presentation:

          Our patient was a middle-aged heavy smoker male with a history of unresectable pancoast tumor. He was referred to the dental clinic with an expanded maxillary metastasis involving the bone and sinus region as well as oral soft tissues. To confirm the primary site of his malignancy, immunohistochemical staining was performed.

          Conclusion:

          Distant metastases of a pancoast tumor are more frequent when the primary tumor is unoperable and bone involvement is one of the early manifestations of disease.

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          Most cited references11

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          Metastatic tumours to the oral cavity - pathogenesis and analysis of 673 cases.

          Abraham Hirshberg, Ilana Kaplan, Anna Shnaiderman … (2008)
          The oral region is an uncommon site for metastatic tumour cell colonization and is usually evidence of a wide spread disease. In 25% of cases, oral metastases were found to be the first sign of the metastatic spread and in 23% it was the first indication of an undiscovered malignancy at a distant site. The jawbones, particularly the mandible, were more frequently affected than the oral soft tissues (2:1). In the oral soft tissues, the attached gingiva was the most commonly affected site (54%). The major primary sites presenting oral metastases were the lung, kidney, liver, and prostate for men, breast, female genital organs (FGO), kidney, and colo-rectum for women. The primary site differs according to oral site colonization, in men the lung was the most common primary site affecting both the jawbones and oral mucosa (22% and 31.3%, respectively) followed by the prostate gland in the jawbones (11%) and kidney in the oral soft tissues (14%). In women, the breast was the most common primary tumour affecting the jawbones and soft tissues (41% and 24.3%, respectively), followed by the adrenal and female genital organs (FGO) in the jawbones (7.7%) and FGO in the soft tissues (14.8%). The clinical presentation of the metastatic lesions differ between the various sites in the oral region. In the jawbones most patients complain of swelling, pain and paresthesia which developed in a relative short period. Early manifestation of the gingival metastases resembled a hyperplastic or reactive lesion, such as pyogenic granuloma, peripheral giant cell granuloma, or fibrous epulis. Because of its rarity, the diagnosis of a metastatic lesion in the oral region is challenging, both to the clinician and to the pathologist, in recognizing that a lesion is metastatic and in determining the site of origin. The clinical presentation of a metastatic lesion in the oral cavity can be deceiving leading to a misdiagnosis of a benign process, therefore, in any case where the clinical presentation is unusual especially in patients with a known malignant disease a biopsy is mandatory.
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            Superior sulcus tumors (Pancoast tumors).

            Giuseppe Marulli, Lucia Battistella, Marco Mammana … (2016)
            Superior Sulcus Tumors, frequently termed as Pancoast tumors, are a wide range of tumors invading the apical chest wall. Due to its localization in the apex of the lung, with the potential invasion of the lower part of the brachial plexus, first ribs, vertebrae, subclavian vessels or stellate ganglion, the superior sulcus tumors cause characteristic symptoms, like arm or shoulder pain or Horner's syndrome. The management of superior sulcus tumors has dramatically evolved over the past 50 years. Originally deemed universally fatal, in 1956, Shaw and Paulson introduced a new treatment paradigm with combined radiotherapy and surgery ensuring 5-year survival of approximately 30%. During the 1990s, following the need to improve systemic as well as local control, a trimodality approach including induction concurrent chemoradiotherapy followed by surgical resection was introduced, reaching 5-year survival rates up to 44% and becoming the standard of care. Many efforts have been persecuted, also, to obtain higher complete resection rates using appropriate surgical approaches and involving multidisciplinary team including spine surgeon or vascular surgeon. Other potential treatment options are under consideration like prophylactic cranial irradiation or the addition of other chemotherapy agents or biologic agents to the trimodality approach.
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              Pancoast tumors: characteristics and preoperative assessment.

              Nikolaos Panagopoulos, Vasilios Leivaditis, Efstratios Koletsis … (2014)
              Superior sulcus tumors (SSTs), or as otherwise known Pancoast tumors, make up a clinically unique and challenging subset of non-small cell carcinoma of the lung (NSCLC). Although the outcome of patients with this disease has traditionally been poor, recent developments have contributed to a significant improvement in prognosis of SST patients. The combination of severe and unrelenting shoulder and arm pain along the distribution of the eighth cervical and first and second thoracic nerve trunks, Horner's syndrome (ptosis, miosis, and anhidrosis) and atrophy of the intrinsic hand muscles comprises a clinical entity named as "Pancoast-Tobias syndrome". Apart NSCLC, other lesions may, although less frequently, result in Pancoast syndrome. In the current review we will present the main characteristics of the disease and focus on the preoperative assessment.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Caspian J Intern Med
                Journal ID (iso-abbrev): Caspian J Intern Med
                Journal ID (publisher-id): CJIM
                Title: Caspian Journal of Internal Medicine
                Publisher: Babol University of Medical Sciences (Babol, Iran )
                ISSN (Print): 2008-6164
                ISSN (Electronic): 2008-6172
                Publication date (Print): Summer 2019
                Volume: 10
                Issue: 3
                Pages: 351-355
                Affiliations
                [1 ]Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
                [2 ]Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
                [3 ]Student. Research Committee, Babol University of Medical Science, Babol, Iran.
                [4 ]Oral Health Research Center, Institute of Health, Babol University of Medical Sciences, Babol, Iran.
                [5 ]Cancer Research Center, Health Research Institute. Babol University of Medical Sciences, Babol, Iran
                Author notes
                [* ]Correspondence: Safoura Seifi, Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. E-mail: sf_seify@yahoo.com, Tel: 0098 32291408-9, Fax: 0098 32291093
                Article
                DOI: 10.22088/cjim.10.3.351
                PMC ID: 6729146
                SO-VID: a225efac-d84e-4246-b4b6-996157282cab
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 20 June 2018
                Date revision received : 29 November 2018
                Date accepted : 15 December 2018
                Categories
                Subject: Case Report

                Keywords: metastatic carcinoma,pancoast tumor,gingival metastasis,immunohistochemical staining.
                Data availability:
                Keywords: metastatic carcinoma, pancoast tumor, gingival metastasis, immunohistochemical staining.

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