Anterior maxillary metastasis of gastric adenocarcinoma: A rare case
A 50-year-old male patient reported to our department with chief complaint of a proliferative swelling in upper labial gingiva since 3-4 months. About 6 months back the right maxillary central and lateral incisors exfoliated and 2 months later patient noticed a small swelling at the same region which attained the present size. It was not associated with pain or any other symptoms.\nIn his medical history, it was noticed that the patient had abdominal discomfort and vomiting on having food from 3 years which had increased since last 10 months. He had undergone endoscopy of upper gastrointestinal tract 3 years back which revealed chronic Helicobacter pylori associated gasritis for which he was on oral medication (proton pump inhibitors) till date. Patient was a chronic bidi smoker since 30 years.\nThere were no significant extraoral findings; also, no significant cervical lymphadenopathy was noticed. An intraoral examination revealed a single, oval proliferative lesion with well-defined borders on the anterior right maxillary labial aspect measuring about 4 × 5 cm extending anterioposteriorly in relation to right first premolar to left central incisor and superioinferiorly from the depth of the labial sulcus up to crest of the ridge []. The color of the lesion was pinkish white with a pebbly irregular surface. When palpated the lesion was soft, painless and pedunclated with a stalk of about 4 cm diameter.\nAt the initial visit patient had bouts of vomiting associated with abdominal pain, hence he was admitted and symptomatically treated. Incisional biopsies were performed from both mesial and distal aspects of the oral lesion and were sent for histopathologic examination which revealed dysplastic glandular epithelial cells arranged in the form of ductal and papillary pattern []. The cells were tall columnar exhibiting dysplastic features in the form of nuclear and cellular pleomorphism, nuclear hyperchromatism, prominent nucleoli and numerous mitotic figures [] suggestive of metastasis of adenocarcinoma of gastrointestinal tract.\nDue to history and current complaint of vomiting and abdominal discomfort, a repeat endoscopy was advised.\nResults of upper gastrointestinal endoscopy revealed a proliferative growth at cardia extending into lesser curvature []; multiple biopsies were taken from the lesion. Biopsy report revealed fragments of gastric mucosa showing intestinal metaplasia. Few other segments showed tumor cells arranged in glands, sheets and papillary projections []. The cells were round to oval with hyperchomatic and vesiculated nuclei, multiple nucleoli, moderate amount of amphophilic cytoplasm and exhibited numerous mitotic figures [] suggestive of moderately differentiated gastric adenocarcinoma.\nLater, on comparison of both reports, a similar origin that is the gastric adenocarcinoma was evident. Hence, it was concluded that the lesion seen in the oral cavity was a secondary metastasis from gastric adenocarcinoma. The case was discussed with tumor board and was decided for palliative chemotherapy.