Treatment strategy for maxillary gingival metastasis arising from gastric adenocarcinoma: A case report and literature review

Miyashita,Hitoshi; Sugazaki,Masaki; Saito,Haruka; Kudo,Chieko; Nagao,Munenori; Ishikawa,Yojiro; Teramura,Satoshi; Shinohara,Fumiaki; Murakami,Kazuhiro

doi:10.3892/mco.2025.2836

Treatment strategy for maxillary gingival metastasis arising from gastric adenocarcinoma: A case report and literature review

Authors:
- Hitoshi Miyashita
- Masaki Sugazaki
- Haruka Saito
- Chieko Kudo
- Munenori Nagao
- Yojiro Ishikawa
- Satoshi Teramura
- Fumiaki Shinohara
- Kazuhiro Murakami
View Affiliations

Affiliations: Department of Dentistry and Oral Surgery, Tohoku Medical and Pharmaceutical University Hospital, Sendai 983‑8512, Japan, Department of Pathology, Tohoku Medical and Pharmaceutical University Hospital, Sendai 983‑8512, Japan, Department of Medical Oncology, Tohoku Medical and Pharmaceutical University Hospital, Sendai 983‑8512, Japan, Department of Supportive Medicine and Care for Cancer, Tohoku Medical and Pharmaceutical University Hospital, Sendai 983‑8512, Japan, Department of Radiology, Tohoku Medical and Pharmaceutical University Hospital, Sendai 983‑8512, Japan
Published online on: March 11, 2025 https://doi.org/10.3892/mco.2025.2836
Article Number: 41
Copyright: © Miyashita et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Gastric cancer metastasizing to the gingiva is rare. The present study reports a case of maxillary gingival metastasis arising from gastric cancer treated with chemotherapy, surgical excision and radiotherapy. A 55‑year‑old male, who received chemotherapy with trifluridine/tipiracil for treatment of refractory gastric cancer with multiple metastasis, was admitted to the Department of Dentistry and Oral Surgery, Tohoku Medical and Pharmaceutical University Hospital (Sendai, Japan) in December 2023 because of the right side of the maxillary gingival mass presenting with protruding growth. The size of the tumor was ~20 mm. Tumor excision was performed followed by histopathological diagnosis which revealed a metastatic gingival tumor originating from gastric adenocarcinoma. Consequently, the patient underwent a palliative Radiation Therapy Oncology Group 8502 ‘QUAD shot’ regimen. Although there was no progression of oral lesion, the patient died 3 months after diagnosis of gingival metastasis. The present study reviewed previous case records of gingival metastasis originating from gastric cancer and summarized treatment modalities along with clinicopathological association. In conclusion, the prognosis of patients with metastases to the oral region (MOR) is usually unfavorable. For the management of MOR, a multidisciplinary team approach is necessary to develop appropriate treatment strategies. If there are possibilities to improve prognosis or quality of life, the consideration of combination therapy with radical or palliative intent is warranted.

View Figures

View References

1	Hirshberg A and Buchner A: Metastatic tumours to the oral region. An overview. Eur J Cancer Part B Oral Oncol. 31B:355–360. 1995.PubMed/NCBI View Article : Google Scholar
2	Hirshberg A, Shnaiderman-Shapiro A, Kaplan I and Berger R: Metastatic tumours to the oral cavity-pathogenesis and analysis of 673 cases. Oral Oncol. 44:743–752. 2008.PubMed/NCBI View Article : Google Scholar
3	Hirshberg A, Berger R, Allon I and Kaplan I: Metastatic tumors to the jaws and mouth. Head Neck Pathol. 8:463–474. 2014.PubMed/NCBI View Article : Google Scholar
4	Kirschnick LB, Schuch LF, Cademartori MG and Vasconcelos ACU: Metastasis to the oral and maxillofacial region: A systematic review. Oral Dis. 28:23–32. 2022.PubMed/NCBI View Article : Google Scholar
5	Shimono H, Hirai H, Oikawa Y, Mochizuki Y, Kuroshima T, Tomioka H, Kayamori K, Ikeda T and Harada H: Metastatic tumors in the oral region: A retrospective chart review of clinical characteristics and prognosis. Oral Surg Oral Med Oral Pathol Oral Radiol. 132:648–652. 2021.PubMed/NCBI View Article : Google Scholar
6	Kirschnick LB, Schuch LF, Gondak R, Rivero ERC, Gomes APN, Etges A, Tarquinio SBC, Mesquita RA, Caldeira PC, da Costa AAS, et al: Clinicopathological features of metastasis to the oral and maxillofacial region-multicenter study. Head Neck Pathol. 17:910–920. 2023.PubMed/NCBI View Article : Google Scholar
7	Kajita T, Miyashita H, Kitamura J, Kouketsu A, Kumamoto H and Takahashi T: Pulmonary pleomorphic carcinoma metastasizing to the anterior mandibular gingiva: A case report and literature review. Int J Surg Case Rep. 98(107499)2022.PubMed/NCBI View Article : Google Scholar
8	Zachariades N: Neoplasms metastatic to the mouth, jaws and surrounding tissues. J Craniomaxillofac Surg. 17:283–290. 1989.PubMed/NCBI View Article : Google Scholar
9	Maschino F, Guillet J, Curien R, Dolivet G and Bravetti P: Oral metastasis: A report of 23 cases. Int J Oral Maxillofac Surg. 42:164–168. 2013.PubMed/NCBI View Article : Google Scholar
10	Jham BC, Salama AR, McClure SA and Ord RA: Metastatic tumors to the oral cavity: A clinical study of 18 cases. Head Neck Pathol. 5:355–358. 2011.PubMed/NCBI View Article : Google Scholar
11	Owosho AA, Xu B, Kadempour A, Yom SK, Randazzo J, Ghossein RA, Huryn JM and Estilo CL: Metastatic solid tumors to the jaw and oral soft tissue: a retrospective clinical analysis of 44 patients from a single institution. J Craniomaxillofac Surg. 44:1047–1053. 2016.PubMed/NCBI View Article : Google Scholar
12	Thrift AP, Wenker TN and El-Serag HB: Global burden of gastric cancer: Epidemiological trends, risk factors, screening and prevention. Nat Rev Clin Oncol. 20:338–349. 2023.PubMed/NCBI View Article : Google Scholar
13	Lund BA, Moertel CG and Gibilisco JA: Metastasis of gastric adenocarcinoma to oral mucosa. Oral Surg Oral Med Oral Pathol. 25:805–809. 1968.PubMed/NCBI View Article : Google Scholar
14	Astacio JN and Alfaro C: Oral mucosa metastasis from gastric adenocarcinoma. Oral Surg Oral Med Oral Pathol. 28:859–861. 1969.PubMed/NCBI View Article : Google Scholar
15	Ohba T, Nakagawa E and Nakata H: Metastatic tumor of the gum. Jpn J Cancer Clin. 20:692–696. 1974.
16	Lopez N and Lobos N: Metastatic adenocarcinoma of gingiva. Report of a case. J Periodontol. 47:358–360. 1976.PubMed/NCBI View Article : Google Scholar
17	Osaki T, Ryoke K and Hamada T: Metastatic adenocarcinoma to the oral cavity: report of two cases and review of literature. Jpn J Stomatol Soc. 27:173–185. 1978.
18	Tojyo Y, Saito K, Aihara H, Tuda Y and Nisimaru Y: The metastasis of gastric adenocarcinoma to the gingiva of the mandible-review of the Japanese literature. Gan No Rinsho. 35:1165–1170. 1989.PubMed/NCBI(In Japanese).
19	Hamakawa H, Takarada M and Tanioka H: Two metastatic tumors of the oral cavity: A histopathologic investigation. J Oral Surg Society Jpn. 39:823–828. 1993.
20	Florio SJ and Hurd TC: Gastric carcinoma metastatic to the mucosa of the hard palate. J Oral Maxillofac Surg. 53:1097–1098. 1995.PubMed/NCBI View Article : Google Scholar
21	Makino S, Omura K and Kitada H: Metastatic mandibular tumor: Report of 7 cases. Jpn J Oral Maxillofac Surg. 43:465–472. 1997.
22	Yajima M and Miyazaki T: Metastasis of gastric adenocarcinoma to the maxillary gingiva: Report of a case. Jpn J Oral Maxillofac Surg. 45:497–499. 1999.
23	Shimoyama S, Seto Y, Aoki F, Ogawa T, Toma T, Endo H, Itouji T and Kaminishi M: Gastric cancer with metastasis to the gingiva. J Gastroenterol Hepatol. 19:831–835. 2004.PubMed/NCBI View Article : Google Scholar
24	Colombo P, Tondulli L, Masci G, Muzza A, Rimassa L, Petrella D and Santoro A: Oral ulcer as an exclusive sign of gastric cancer: Report of a rare case. BMC Cancer. 5(117)2005.PubMed/NCBI View Article : Google Scholar
25	Kwon MS, Ko SO, Cho NP, Kim OH, Shin HK, Baek JA and Leem DH: Gastric signet-ring cell adenocarcinoma metastatic to the gingiva: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 102:62–66. 2006.PubMed/NCBI View Article : Google Scholar
26	Nishide N and Kanamura N: The value of carcinoembryonic antigen staining to determine the primary malignancy in metastatic carcinoma to the gingiva. Am J Clin Oncol. 29:316–317. 2006.PubMed/NCBI View Article : Google Scholar
27	Hwang KG, Park CJ, Paik SS and Shim KS: Gingival metastasis from gastric adenocarcinoma. Otolaryngol Head Neck Surg. 137:169–170. 2007.PubMed/NCBI View Article : Google Scholar
28	Uchiyama Y, Murakami S, Kakimoto N, Nakatani A, Kishino M, Hamab Y and Furukawa S: Diagnostic imaging findings for mandibular metastasis from gastric adenocarcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 107:e49–e53. 2009.PubMed/NCBI View Article : Google Scholar
29	Sauerborn D, Vidakovic B, Baranovic M, Mahovne I, Danic P and Danic D: Gastric adenocarcinoma metastases to the alveolar mucosa of the mandible: A case report and review of the literature. J Craniomaxillofac Surg. 39:645–648. 2011.PubMed/NCBI View Article : Google Scholar
30	Guo Y, Chen DF, Li P and CH L: Gingival metastasis from gastric cancer: 1 case report. Chin J Gastmenterol. 17(384)2012.
31	Kalaitsidou IG, Astreidis IT, Kontos KI, Lazaridou MN, Bourlidou ET, Gerasimidou DK, Vladika NP and Mangoudi DL: Metastatic tumours to the oral cavity: Report of three cases. J Oral Maxillofac Res. 6(e5)2015.PubMed/NCBI View Article : Google Scholar
32	Wu Z, Tang J, Li Y, Lu H, Xu J and Lv D: Successful management of rare gingival metastasis from gastric adenocarcinoma: A case report and literature review. World J Surg Oncol. 15(141)2017.PubMed/NCBI View Article : Google Scholar
33	Soares CD, Rocha BA, Paranaiba LMR, de Melo-Filho MR, Jorge J, de Carvalho MGF and de Almeida OP: A challenging diagnosis: Case report of oral metastasis from gastric adenocarcinoma mimicking pyogenic granuloma. Medicine (Baltimore). 97(e9934)2018.PubMed/NCBI View Article : Google Scholar
34	Ayşegul A, Ahmet K, Abdullah Y, Merva ST and Sidar B: Gastric carcinoma metastases to the anterior maxilla: A rare case report. Int J Oral Med Sci. 17:129–132. 2018.
35	Sohrabi C, Mathew G, Maria N, Kerwan A, Franchi T and Agha RA: Collaborators. The SCARE 2023 guideline: Updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg. 109:1136–1140. 2023.PubMed/NCBI View Article : Google Scholar
36	Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma 2017. 15th edition. Kanehara Shuppan, Tokyo, 2017.
37	Japanese Gastric Cancer Association: Japanese gastric cancer treatment guidelines 2021. 6th edition. Gastric Cancer. 26:1–25. 2023.PubMed/NCBI View Article : Google Scholar
38	Allon I, Pessing A, Kaplan I, Allon DM and Hirshberg A: Metastatic tumors to the gingiva and the presence of teeth as a contributing factor: A literature analysis. J Periodontol. 85:132–139. 2014.PubMed/NCBI View Article : Google Scholar
39	Irani S: Metastasis to the oral soft tissues: A review of 412 cases. J Int Soc Prev Community Dent. 6:393–401. 2016.PubMed/NCBI View Article : Google Scholar
40	Ellis GL, Jensen JL, Reingold IM and Barr RJ: Malignant neoplasms metastatic to gingivae. Oral Surg Oral Med Oral Pathol. 44:238–245. 1977.PubMed/NCBI View Article : Google Scholar
41	Lok BH, Jiang G, Gutiontov S, Lanning RM, Sridhara S, Sherman EJ, Tsai CJ, McBride SM, Riaz N and Lee NY: Palliative head and neck radiotherapy with the RTOG 8502 regimen for incurable primary or metastatic cancers. Oral Oncol. 51:957–962. 2015.PubMed/NCBI View Article : Google Scholar
42	Toya R, Saito T, Yamaguchi K, Matsuyama T, Watakabe T, Matsumoto T, Yoshida R, Hirosue A, Murakami D, Orita Y, et al: Hypofractionated palliative volumetric modulated arc radiotherapy with the radiation oncology study group 8502 ‘QUAD shot’ regimen for incurable head and neck cancer. Radiat Oncol. 15(123)2020.PubMed/NCBI View Article : Google Scholar
43	Takahashi S, Endo M, Nagatomo T, Onaga R, Yamaguchi H, Yamamoto R, Fukuda Y, Ogawa K, Nakamura M, Okada K, et al: Successful preoperative QUAD SHOT for bulky parotid carcinoma: Potential preoperative ultra-hypofractionated radiotherapy for conversion surgery. Case Rep Oncol. 16:218–226. 2023.PubMed/NCBI View Article : Google Scholar
44	National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology, Head and Neck Cancers (version 1). 2020.
45	Lee YH and Lee JI: Metastatic carcinoma of the oral region: An analysis of 21 cases. Med Oral Patol Oral Cir Bucal. 22:e359–e365. 2017.PubMed/NCBI View Article : Google Scholar