Metastatic Lung Cancer to the Head and Neck: A Clinico-Pathological Study on 21 Cases with Narrative Review of the Literature

Abstract

Metastases from lung cancer to the oral cavity and to the head and neck generally are very infrequent and usually manifest in advanced stages of the disease. Even more rarely, they are the first sign of an unknown metastatic disease. Nevertheless, their occurrence always represents a challenging situation both for clinicians, in the management of very unusual lesions, and for pathologists, in the recognition of the primary site. We retrospectively studied 21 cases of metastases to the head and neck from lung cancer (sixteen males and five females, age range 43–80 years; eight cases localized to the gingiva [two of these to the peri-implant gingiva], seven to the sub-mandibular lymph nodes, two to the mandible, three to the tongue, one case to the parotid gland; in eight patients, metastasis was the first clinical manifestation of an occult lung cancer) and proposed a wide immunohistochemical panel for a proper identification of the primary tumor histotype, including CK5/6, CK8/18, CK7, CK20, p40, p63, TTF-1, CDX2, Chromogranin A, Synaptophysin, GATA-3, Estrogen Receptors, PAX8, PSA. Furthermore, we collected data from previously published studies and narratively reviewed the relevant literature.

Metastasis of Lung Adenocarcinoma Around Mandibular Dental Implant: A Clinical Case Report

“…Several studies have reported that chronic inflammatory conditions may affect malignant tumor development. 8,18,19 With less clear evidence, claims have been made that the presence of implants can promote cell metastasis and metastatic growth. 8 The peri-implant area is more vulnerable to infection than is the area around natural teeth, which is more likely to remain in a chronic inflammatory condition.…”

“…PET/CT and bone scans can aid the diagnosis, as in this case, a suspicious lesion existed in the oral cavity. 17,19 However, to prevent delays in appropriate treatment, a tissue biopsy must be considered.…”