LUNG CARCINOMA METASTASIS TO THE MAXILLA AFTER RECURRENT IMPLANTS FAILURE

Abstract

Metastatic tumours involving the oro-facial tissues are infrequent, with an incidence ranging between 1-8% of oral malignant tumours. The peak incidence is in the 5-7th decades and they can be the first sign of an occult cancer or manifest during the follow-up of a patient with a known primary tumour. We describe a case of metastasis from unknown lung adenocarcinoma occurring in the maxilla, around dental implants, causing recurrent implants failure. A 62 year-old male without relevant clinical history was referred for dental implant failure in the left maxilla. New dental implants were positioned in the same maxillary area, but an additional implant failure occurred one month later; implants removal with an accurate bone curettage was performed and the surgical sample sent for histological examination. Unexpectedly, small foci of adenocarcinoma were found, with spiculae of medullary bone, prominent inflammatory changes and bacterial deposits. At immunohistochemistry, the tumour positively stained for CK7+ and TTF1+ but not for CK20 and PSA. Additional clinico-radiological investigations revealed a primary tumour of the lung, subsequently characterized as acinar adenocarcinoma. Metastases to the oro-facial tissues can involve the oral mucosa, jawbones and salivary glands; lung, kidney, prostate and colon-rectum in males, uterus, breast, ovary and lungs in females are the most frequent primary localisations. It is accepted that metastatic neoplasms in the oro-facial region show high predilection for sites with peculiar clinical conditions, such as the parodontal inflammation or edentulous individuals bearing prosthesis. The molar and premolar regions of the jawbones and the post-extraction sites frequently are involved; this was related to the rich vascularisation and high bone marrow content and /or to re-organisation of the blood cloth of such sites. This report highlights the importance of histological examination of gingival-parodontal inflamed tissues when plaque and calculus accumulations have been excluded as primary causes.