Elkhoury Jad, Cacchillo David A, Tatakis Dimitris N, Kalmar John R, Allen Carl M, Sedghizadeh Parish P
Section of Periodontology, The Ohio State University, College of Dentistry, Columbus, OH 43218-2357, USA.
J Periodontol. 2004 Sep;75(9):1295-9. doi: 10.1902/jop.2004.75.9.1295.
Metastases to the gingiva are uncommon. They can be a diagnostic challenge clinically because of their rarity and tendency to mimic benign lesions. In this report, we present a case of an undifferentiated malignant neoplasm of unknown origin presenting as benign inflammatory gingival lesions and we review the literature on metastases to the gingiva.
A 44-year-old female patient was referred by a local periodontist for evaluation of multiple painless gingival lesions that clinically resembled pyogenic granulomas or periodontal abscesses, but with an uncharacteristic multifocal presentation in the background of good oral hygiene. Her medical history was unremarkable except for recent weight loss. Periapical radiographs were obtained, as well as two incisional biopsies, one placed in formalin for routine histology and immunohistochemistry, the other in phosphate buffered saline for flow cytometry.
Radiographic findings were non-contributory for hard tissue pathoses. Histopathological findings were consistent with a poorly differentiated malignancy, suggestive of metastatic disease. Immunohistochemical studies and flow cytometry were unsupportive in delineating any tumor differentiation. The patient subsequently developed multiple tumors throughout the body with similar histopathological findings, yet no primary tumor was identified and a definitive diagnosis could not be rendered. She was discharged one month later in poor condition with the principal diagnosis of hemorrhage/ pancytopenia, and a secondary diagnosis of metastatic head and neck cancer.
This case of malignant metastatic tumor of unknown origin presenting as benign gingival lesions illustrates the importance of thorough patient evaluation, which should include a biopsy when necessary for definitive diagnosis.
牙龈转移瘤并不常见。由于其罕见性以及易于模仿良性病变的倾向，在临床上可能构成诊断挑战。在本报告中，我们呈现了一例起源不明的未分化恶性肿瘤，其表现为良性炎症性牙龈病变，并回顾了有关牙龈转移瘤的文献。
一名44岁女性患者由当地牙周病医生转诊，以评估多个无痛性牙龈病变，这些病变在临床上类似于化脓性肉芽肿或牙周脓肿，但在口腔卫生良好的背景下呈现出不典型的多灶性表现。除近期体重减轻外，她的病史无异常。拍摄了根尖片，并进行了两次切开活检，一次置于福尔马林中用于常规组织学和免疫组织化学检查，另一次置于磷酸盐缓冲盐水中用于流式细胞术检查。
影像学检查结果对硬组织病变无诊断价值。组织病理学检查结果与低分化恶性肿瘤一致，提示转移性疾病。免疫组织化学研究和流式细胞术检查在明确肿瘤分化方面均无支持作用。该患者随后全身出现多个具有相似组织病理学表现的肿瘤，但未发现原发性肿瘤，无法做出明确诊断。一个月后，她病情不佳出院，主要诊断为出血/全血细胞减少症，次要诊断为头颈部转移性癌。
本病例中起源不明的恶性转移瘤表现为良性牙龈病变，说明了全面评估患者的重要性，必要时应包括活检以明确诊断。
