Oral metastases: report of 24 cases

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Abstract

Aim: To study patients with oral metastatic tumours for the distribution of sex and age, the oral site and histopathological type of the metastasis, the primary tumour site and length of follow-up. Patients and methods: All patients who had an oral metastasis diagnosed during the period January 1970–January 2001 at the Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Centre, Amsterdam, The Netherlands, were included in this retrospective case study. Results: Of 1537 patients with newly diagnosed oral cancers, 24 had metastatic tumours. There was an equal sex distribution and age at the time of diagnosis ranged from 8 to 90 years (median 60). The metastatic tumours most commonly involved the bone (18/24), the mandible being the most common (15/18). The predominant histological type was adenocarcinoma. In most patients (n=16) the primary tumour was already known before the oral metastatic lesion appeared. The most common primary tumours were breast, lung, kidney, and prostate, in that order. Prognosis was poor (median survival 6 months, range 1–60). Conclusions: Oral metastases are rare and may present at any age in both sexes and predominantly involve bony structures, particularly the mandible. A third of oral metastases appeared to be the first indication of an occult malignant process elsewhere.

Section snippets

INTRODUCTION

About 1% of all oral cancers are metastases of primary tumours elsewhere in the body, and are located in the soft tissues as well as in the jaw bones.

Almost all types of malignancy may metastasise to the mouth. Although no particular malignancies seem to favour spread to the oral cavity, some primary tumours are found more often than others. For instance, primary lung tumours are more likely to metastasise to the mouth in men than in women, because men have a higher incidence of lung cancer.1.,

PATIENTS AND METHODS

All patients who had an oral metastasis diagnosed in the period January 1970–January 2001 at the VU University Medical Centre were studied retrospectively from the histopathological database and the medical records (ICD-9 codes 140, 141, and 143–145). Apart from sex and age of the patients, the clinical presentation and histopathological picture of the oral metastasis were recorded as well as the site of the primary tumour, the results of further dissemination studies, treatment, and the course

RESULTS

In the 30-year period studied, 1537 new cases of oral malignant tumours were identified. The present study concerns our experience of 24 patients in whom the diagnosis of an oral metastasis from a primary tumour located elsewhere had been established (Table 1).

DISCUSSION

Metastasising is a complex process,5 the biological basis of which requires tumour cells to breach a sequence of barriers.5 First, they have to detach from the primary tumour; then they must spread in the tissue, invade the blood or lymphatic vessels, and survive travel in the circulation. After this they have to settle in the microvasculature of the organ, extravasate through the vessel wall, invade the target organ, and proliferate within the target tissue.5., 6. For a micrometastasis to grow

Acknowledgements

We thank Mrs M.J. Oostindiër, Comprehensive Cancer Centre West, Leiden, The Netherlands, and Ms E.A. van der Wilk, National Institute of Public Health and the Environment, Bilthoven, The Netherlands, for providing detailed figures for the incidence of cancer as well as for valuable discussion. The authors have no conflict of interest or funding sources to disclose.

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Copyright © 2003 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.