CPCClinical Case Study              Majd Hasanin
Chief Complaint “A 40 year old male patient complaining of painful intraoral swelling on lower left posterior side of jaw”...
History• Medical History:  – Previous history of Lung Tumor (5 years back).  – The patient has been a smoker for 9 years, ...
Clinical Examination• Extra-oral Examination revealed:  – Left submandibular lymph nodes were enlarged,    tender and mobi...
Clinical Examination• Intra-oral Examination, revealed:  – A reddish-pink pedunculated growth extending    from mesial of ...
Intra-oral PhotographIntraoral picture showing reddish-pink pedunculated growthextending from mesial of 36 to distal of 38...
Panoramic Radiograph             Majd Hasanin
Differential Diagnosis•   Pyogenic granuloma.•   Metastatic Carcinoma.•   Squamous cell carcinoma.•   Osteomyelitis.      ...
HistopathologyPhotomicrograph showing multiple nucleoli, mitotic figuresand presence of clear cells. (H and E, ×40)       ...
HistopathologyPhotomicrograph showing multiple nucleoli, mitotic figuresand presence of clear cells. (H and E, ×40)       ...
Chest X-RayX-ray chest PA view showing homogenous radio opaque lesionon right upper zone, with rest of the clear field.   ...
Definitive DiagnosisMetastasis of lung cancer to the oral cavity.                   Majd Hasanin
Treatment Surgical resection of the gingival tumor, after treating the primary origin of it, where the oncologist will dec...
Metastasis to the Oral       Cavity         Majd Hasanin
Introduction• Metastatic tumors of oral cavity are  uncommon and may occur in oral soft tissues  or jaw bones.• Because of...
Introduction, cont.• Etiology: Lymphatic or hematogenous  (bloodborne) spread of malignancies.• Incidence: Rare; 1% of all...
Clinical Features•   Appear as a Nodule or a Mass.•   Very prone to ulceration if traumatized.•   Prognosis is generally p...
Metastatic LesionsPrimary Site:Colon.                         Lung.                Majd Hasanin
Metastatic LesionsPrimary Site:Kidney.                        Breast.                Majd Hasanin
Treatment Options•   Surgical Resection.•   Radiotherapy.•   Chemotherapy.•   Combination of all.                         ...
Thank You all for your kind        attention            Majd Hasanin
References:• Indian Journal of Dental Research:  Moharil RB, Khandekar S, Dive A. Metastatic lung malignancy  to mandibula...
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Metastesis

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  1. 1. CPCClinical Case Study Majd Hasanin
  2. 2. Chief Complaint “A 40 year old male patient complaining of painful intraoral swelling on lower left posterior side of jaw”.History of the Chief Complaint: Started 20 days before his visit to the clinic. Majd Hasanin
  3. 3. History• Medical History: – Previous history of Lung Tumor (5 years back). – The patient has been a smoker for 9 years, and there was no cessation, even after the cancer.• Dental History: – Several extracted teeth. – Multiple restored teeth. Majd Hasanin
  4. 4. Clinical Examination• Extra-oral Examination revealed: – Left submandibular lymph nodes were enlarged, tender and mobile, other lymph nodes were not involved. – No other abnormalities were found. Majd Hasanin
  5. 5. Clinical Examination• Intra-oral Examination, revealed: – A reddish-pink pedunculated growth extending from mesial of tooth # 36 to distal of tooth # 38, having approximate size of 5 × 2 cm. – Irregular in shape and soft to firm in consistency. – Findings of pus discharge. – Bleeding on probing and; – Slough with indentations were noted Majd Hasanin
  6. 6. Intra-oral PhotographIntraoral picture showing reddish-pink pedunculated growthextending from mesial of 36 to distal of 38, approximate size of 5×2cm, irregular in shape. Majd Hasanin
  7. 7. Panoramic Radiograph Majd Hasanin
  8. 8. Differential Diagnosis• Pyogenic granuloma.• Metastatic Carcinoma.• Squamous cell carcinoma.• Osteomyelitis. Majd Hasanin
  9. 9. HistopathologyPhotomicrograph showing multiple nucleoli, mitotic figuresand presence of clear cells. (H and E, ×40) Majd Hasanin
  10. 10. HistopathologyPhotomicrograph showing multiple nucleoli, mitotic figuresand presence of clear cells. (H and E, ×40) Majd Hasanin
  11. 11. Chest X-RayX-ray chest PA view showing homogenous radio opaque lesionon right upper zone, with rest of the clear field. Majd Hasanin
  12. 12. Definitive DiagnosisMetastasis of lung cancer to the oral cavity. Majd Hasanin
  13. 13. Treatment Surgical resection of the gingival tumor, after treating the primary origin of it, where the oncologist will decide the best treatment option for the patient. Majd Hasanin
  14. 14. Metastasis to the Oral Cavity Majd Hasanin
  15. 15. Introduction• Metastatic tumors of oral cavity are uncommon and may occur in oral soft tissues or jaw bones.• Because of their rarity, metastasis to oral cavity are challenging to diagnose and difficult to treat.• They often have vague symptoms that mimic dental infections.• The most common malignancy in the oral cavity (90% of tumors) is oral SCC. Majd Hasanin
  16. 16. Introduction, cont.• Etiology: Lymphatic or hematogenous (bloodborne) spread of malignancies.• Incidence: Rare; 1% of all oral malignancies.• Gender: Male > Females. Primary Malignancy; – Males: Lung. – Females: Breast; lung will likely increase.• Age: Middle-aged, older adults.• Site: Gingiva (most common site), then the Tongue. Majd Hasanin
  17. 17. Clinical Features• Appear as a Nodule or a Mass.• Very prone to ulceration if traumatized.• Prognosis is generally poor.• Histology of the examined lesion will be similar to that of the primary malignancy. Majd Hasanin
  18. 18. Metastatic LesionsPrimary Site:Colon. Lung. Majd Hasanin
  19. 19. Metastatic LesionsPrimary Site:Kidney. Breast. Majd Hasanin
  20. 20. Treatment Options• Surgical Resection.• Radiotherapy.• Chemotherapy.• Combination of all. Majd Hasanin
  21. 21. Thank You all for your kind attention Majd Hasanin
  22. 22. References:• Indian Journal of Dental Research: Moharil RB, Khandekar S, Dive A. Metastatic lung malignancy to mandibular gingiva. Indian J Dent Res [serial online] 2010 [cited 2011 Mar 5];21:449-51. Available from: http://www.ijdr.in/text.asp?2010/21/3/449/70795• www.pringerlink3.metapress.com• www.sciencedirect.com• www.pubmed.org• Oral Radiology, principles and interpretation (fifth edition). For: White and Pharoah Majd Hasanin

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