Peri-Implant Metastasis as First Manifestation of an Unknown Lung Cancer: Literature Review and Two New Cases

Abstract

Metastasis around dental implant are extremely rare. They usually represent a secondary localization of a multi-organ metastatic neoplasm but also, exceptionally, recognized as first clinical manifestation of a still unknown cancer of whatever organ. Metastases usually manifest as rapidly growing lesions of hard and soft tissues, and always represent a true diagnostic/therapeutic dilemma both for clinicians, in choosing the more appropriate treatment, and for pathologists to recognize the primary tumor when still un-diagnosed. We report two distinct cases of metastasis both occurring around dental implants in the maxilla and mimicking perimplantitis at the onset; more precisely, in one case lesion involved exclusively the alveolar bone where implant were previously inserted, while in the other case neoplasm caused bone destruction around the fixture with an impressive and rapid exophytic growth. In both cases, maxillary lesions were the first metastatic manifestation of an unknown adenocarcinoma of the lung.

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

“…The patient group was composed of sixteen males and five females, and the age range was from 43 to 80 years old. In eight cases the metastases involved the gingiva (two of these cases were localized to the peri-implant gingiva; such cases have been already published) [ 8 ]; in seven cases the sub-mandibular lymph nodes, in two cases the mandible (intra-osseous), in three other cases the tongue, and in one case the parotid gland. In eight patients, the metastasis was the first clinical manifestation of an occult LC, while in the remaining cases it was an adjunctive localization of a multi-organ metastatic disease.…”

“…In one case, the gingival lesion occurred on the adherent gingiva of upper premolars, showing a relatively small size and thus resembling a common periodontal disease also at the periapical radiograms ( Figure 3 ). Inflammatory signs, such as perimplantisis and/or perimucositis, were also detected in two cases located around the dental implants (such cases have been previously published) [ 8 ]. Tongue metastases clinically appeared as submucosal nodular masses ( Figure 4 ), while parotid gland involvement manifested as a non-specific swelling ( Figure 5 ).…”

“…In the current study, seven metastases involved submandibular lymph nodes, thus confirming them as an elective target for lymphogenous metastatic LCs. Their clinical identification is very difficult to achieve, as the differential diagnosis includes inflammatory diseases of the major salivary glands and lymph nodes, equally characterized by a similar unspecific clinical presentation, with painless/painful rapid swelling of a variable consistence too; moreover, benign and malignant primary tumors are certainly to be considered in the diagnostic work-up [ 2 , 7 , 8 , 9 ].…”

“…In addition, the poor attitude of general dentists to collecting samples for cyto-histological examination of suspicious lesions surely represents an adjunctive contributing factor to such delays. Data from literature generally confirmed a constant delay (about six months) in oral cavity metastasis recognition and diagnosis, thus leading to an overall poor prognosis in such patients [ 4 , 5 , 6 , 7 , 8 , 35 , 36 , 37 , 38 , 52 , 53 , 68 , 69 ]. Nevertheless, it is difficult to assess whether overall survival could improve with an earlier onset of therapy as oral metastases are usually recognized in the advanced stage of the disease; however, this should represent a future perspective, especially thanks to the continuous innovation in medical treatments (targeted therapy and immunotherapy) of the past decade possibly associated with conventional chemo-radiotherapy [ 70 , 71 , 72 ].…”

“…Metastases to the oro-facial tissues may involve the oral mucosa (mostly the gingiva and more rarely the tongue, with a prevalence of 0.17%), the jawbones (especially the mandible), the salivary glands, the soft tissues and the post-extraction sites. The most common primary site may differ on the basis of gender; in males, the most frequent origin of oro-facial metastases is the lung, followed by the kidney, prostate and colon-rectum, while in females it is the uterus, followed by the breast, lung and ovary [ 4 , 5 , 8 , 9 , 10 , 11 , 12 ]. Adenocarcinoma is the most common histologic type of primary lung cancer (LC), which is furthermore showing an increasing incidence worldwide [ 13 ].…”