Gastroesophageal junction adenocarcinoma metastasizing to gingiva
A 60-year-old male patient, known case of adenocarcinoma of gastroesophageal (GE) junction on chemotherapy, presented with a soft exophytic swelling over gingiva of right lower jaw in the first and second pre-molar space. It gradually increased in size with loosening of the overlying teeth. Oral examination showed a soft swelling measuring 3 cm × 2 cm covered by necrotic tag. The swelling resembled periodontal pyogenic abscess or granuloma like hyperplastic lesion []. There was no evidence of lymphadenopathy. Patient was a chronic tobacco chewer and alcoholic. He had a significant dysphagia 1 year back. During his work-up, computed tomography scan revealed a growth at GE junction [], which was reported as adenocarcinoma on histopathology []. Patient was put on chemotherapy.\nBiopsy from the gingival mass was taken. Grossly, we received three tiny pieces of grey white tissue, which were submitted entirely. Microscopy revealed a tumor composed of cuboidal to columnar cells having pleomorphic vesicular nuclei with prominent nucleoli and a moderate amount of eosinophilic to clear cytoplasm arranged predominantly in papillary and focally in acinar pattern. Few cells with bizarre nuclei and signet ring configuration were noted. Areas of tumor necrosis were seen. A diagnosis of papillary adenocarcinoma was offered []. Slides of the primary tumor were reviewed. Microscopy of the primary tumor and gingival mass showed a similar histological feature. Hence the diagnosis of metastatic adenocarcinoma was confirmed. Following this, the patient received one cycle of local radiotherapy.