Gingival metastasis as first sign of multiorgan dissemination of epithelioid malignant mesothelioma

Our plain-English summary of Gingival metastasis as first sign of multiorgan dissemination of epithelioid malignant mesothelioma, by A. Billè, M. Platania, G. Pelosi, et al (Journal of Thoracic Oncology, 2014).

The study

• Authors: A. Billè, M. Platania, G. Pelosi, B. Padovano, P. Quattrone, U. Pastorino
• Journal: Journal of Thoracic Oncology
• Published: 2014;9(8):1226-9
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Metastatic malignant mesothelioma to the oral cavity is extremely rare. They are more common in the jaw bones than the soft tissue. Occurrence of the malignant disease typically carries an average survival rate of 9-12 months

Methods: : Thirteen patients underwent neoadjuvant chemotherapy and radical pleurectomy decortication, followed by radiotherapy from August 2012 to September 2013. Patients were followed up with computed tomography of the chest and the abdomen every 3 months. All patients were followed up until February 2014.

Results: In January 2014, 11 patients were still alive with a median survival of 11 months, eight patients developed a recurrence and two patients died at 8 and 9 months after surgery. After 1 year from macroscopic radical pleurectomy decortication, a 68-year-old man suffered from gingival mass turned out to be a metastatic deposit of biphasic malignant mesothelioma as first sign of multiorgan recurrence. The patient underwent chemotherapy and local radiotherapy in the oral cavity.

Conclusions: This case points out the relevance of biopsy to all new growing lesions, even in uncommon anatomical sites, whenever a history of mesothelioma is on record.

In plain English

This brief report described 13 patients with malignant pleural mesothelioma and focused on one of them. Between August 2012 and September 2013, all 13 received chemotherapy with cisplatin and pemetrexed, then pleurectomy decortication surgery and radiotherapy. At the last follow-up in January 2014, 11 of the 13 were alive, with a median survival of 11 months (range 6 to 17 months). Two had died, at 8 and 9 months after surgery. Five showed no recurrence, seven had recurrence in the pleural cavity, and one had distant spread. The featured patient was a 68-year-old man whose original pleural tumor was epithelioid. About a year after surgery, a painless growth appeared on his lower gum and eroded the jawbone. Tissue examination showed biphasic malignant mesothelioma, and PET/CT scans also showed spread to the adrenal glands and recurrence in the chest. The authors concluded that new lesions, even in unusual sites such as the mouth, should be biopsied early in patients with a history of mesothelioma. The article did not mention asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Brief report: a case report of one patient, presented within a small series of 13 surgically treated patients
• Who was studied: 13 patients with malignant pleural mesothelioma treated between August 2012 and September 2013, followed by CT every 3 months. The featured case was a 68-year-old man from this group. The authors are at the Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
• Main results:
  • Of the 13 patients, 11 were alive at the last follow-up in January 2014, with a median survival of 11 months (range 6–17 months). Two patients died, at 8 and 9 months after surgery.
  • Among the 13 patients, 5 had no local or distant recurrence, 7 had local recurrence in the pleural cavity, and 1 had distant metastasis at 12 months after surgery.
  • One year before the gum lesion, the featured patient had received neoadjuvant cisplatin and pemetrexed, with a partial response after four cycles.
  • The 68-year-old man had a painless growth of the gum near the lower front teeth, which eroded the mandibular (lower jaw) bone.
  • Tissue examination of the gum lesion showed biphasic malignant mesothelioma with a pleomorphic appearance.
  • The original pleural tumor in this patient was epithelioid, with a Ki-67 labeling index (a measure of cell proliferation) of 60%. The gum metastasis had a Ki-67 labeling index of 95%.
  • In this patient, PET/CT showed local recurrence on the left side of the chest near the surgical incision, and distant recurrence in the adrenal glands and the mandibular region.
• The authors' conclusion: The authors concluded that lesions, even in uncommon sites such as the oral cavity, should be biopsied early in patients with a previous history of malignant pleural mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Metastasis, Epithelioid, Malignant Mesothelioma, Neoadjuvant Chemotherapy, Median Survival, Biphasic Mesothelioma, Chemotherapy, Biopsy.

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