A 60-year-old female patient presented to the oral surgery clinic with gingival swelling. The patient had a history of colorectal cancer that was diagnosed a year ago. For treatment, she underwent surgery and received chemotherapy.
The patient first noticed the mass while brushing her teeth, when bleeding occurred. On examination, a pedunculated, non-tender, large mass extending from the border of the buccal gingiva to the lower right second premolar and lingual border was evident. The surface of the mass was friable with presence of dental indentations on the occlusal surfaces of molars, which suggest, suggesting chronicity.
Histopathological analysis
An excisional biopsy was performed: histopathology showed an infiltrating tumour, probably of colorectal origin and consistent with adenocarcinoma. 2 weeks later the patient was called for a follow-up visit and a further debulking of the tumour was performed. PET scan of the tumour showed multiple visceral metastasis.
Colorectal adenocarcinoma metastasis
It is quite predictable for colorectal carcinoma to metastasise, initially via the lymphatic route followed by the hematogenous route. The most common sites for distant metastasis of colorectal adenocarcinoma are the lungs and liver. Metastatic tumours in the oral region are uncommon and account for only 1% of all malignant tumours. Metastasis can occur in the jawbones or oral soft tissues. Metastatic tumours in the jawbone are more commonly reported compared to those in the oral mucosa. Cancers of the colorectum, bone, kidney, lung and breast are the most common primary sources of tumours metastasising in the oral region.
The patient was enrolled in a clinical trial for chemotherapy, however, was eventually lost to follow-up.
References
Khanna, S., & Sengupta, T. (2020). Oral Metastasis of Colorectal Cancer. New England Journal of Medicine, 383(7), e47.
