Metastases to the oral region from pleural mesothelioma: Clinicopathologic review

Our plain-English summary of Metastases to the oral region from pleural mesothelioma: Clinicopathologic review, by S.H. Sinon, A.M. Rich, H.M. Hussaini, et al (Head & Neck, 2013).

The study

• Authors: S.H. Sinon, A.M. Rich, H.M. Hussaini, H.S. Yoon, N.A. Firth, G.J. Seymour
• Journal: Head & Neck
• Published: 2013;35(4):599-604
• Type of article: Review
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant mesothelioma is a rare neoplasm that usually develops after exposure to asbestos and particularly involves the pleural cavity. It has a poor prognosis with aggressive local invasion and metastatic spread.

Methods: The literature relating to malignant mesothelioma metastatic to the oral region was reviewed.

Results: In all, 14 cases of malignant mesothelioma metastatic to the oral cavity were found. All were from pleural mesotheliomas, the tongue was the most common site of metastasis (8/14), and most metastases (9/13) were of the epithelioid type. The newly reported case is only the second report of a mesothelioma metastasizing to the buccal mucosa. It showed strong immunopositivity for keratin markers, vimentin, calretinin, and Wilms tumor product-1.

Conclusions: The incidence of mesothelioma is predicted to continue to increase for at least another decade. Clinicians and pathologists should be aware of this lesion and its propensity to metastasize to the oral cavity.

Copyright © 2011 Wiley Periodicals, Inc.

In plain English

This article combined a review of published cases with a new case report. The authors searched English-language PubMed references and reference lists for malignant mesothelioma that had spread (metastasized) to the mouth. They found 14 previously reported cases. All came from pleural mesothelioma (the lining of the chest). In one case the mouth lesion was the first sign of the disease. Eleven patients were men, and the average age at diagnosis was 60 years. The tongue was the most common site (8 of 14 cases), and most metastases (9 of 13) were of the epithelioid type. Of 9 patients with follow-up, 5 had died by the time their cases were published, and the other 4 were alive with multiple metastases. The new case was a 65-year-old man with a lump in the cheek lining (buccal mucosa) about a year after a pleural mesothelioma diagnosis. Tissue tests confirmed epithelioid mesothelioma, and the patient died 3 months later. This article did not describe asbestos exposure for the new patient or the reviewed cases. The authors concluded that accurate tissue diagnosis helps avoid futile surgery.

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: Literature review of published case reports of mesothelioma metastatic to the oral region, plus a new case report
• Who was studied: 14 previously reported cases of malignant mesothelioma metastatic to the oral cavity (published 1993 to 2011), plus one new case: a 65-year-old man whose biopsy was sent from a provincial New Zealand hospital to the University of Otago
• Exposure: This article does not give asbestos exposure histories or fiber types, either for the new patient or for the reviewed cases. That does not mean the patients were unexposed. For the new patient, the article says only that pleural malignant mesothelioma had been diagnosed about 1 year before the oral lesion and that no other medical history was provided.
• Main results:
  • In the 14 reviewed cases, 11 patients were men (male-to-female ratio 3.7:1), and the average age at diagnosis was 60 years (range 45 to 73 years)
  • All but one reviewed patient had a prior diagnosis of pleural mesothelioma. In case 14, the oral lesion was the first evidence of the disease, and pleural mesothelioma was diagnosed afterward.
  • Where the type of the primary tumor was stated, the primary tumors in the reviewed cases were mostly epithelioid mesotheliomas (7 of 11)
  • In the reviewed cases, the tongue was the most common site of the oral metastasis (8 of 14 cases)
  • Most metastases in the reviewed cases (9 of 13) were of the epithelioid type
  • Of the 9 reviewed patients with follow-up, 5 had died by the time their cases were reported. The remaining 4 were alive but had multiple metastases.
  • The new case was only the second report of mesothelioma metastasizing to the buccal mucosa
  • In the new case, the 0.8-cm buccal mass was diagnosed as metastatic epithelioid mesothelioma. It was strongly positive for CK5/6, CK7, Cam5.2, EMA, vimentin, calretinin and WT1, and negative for CK20, CEA and TTF1. The patient died 3 months after the oral metastasis was diagnosed.
• The authors' conclusion: The authors concluded that this lesion should be considered when diagnosing oral lesions. They stated that the diagnosis should rest on the tissue's histologic and immunohistochemical features rather than on a prior history alone, and that accurate diagnosis helps avoid inappropriate futile surgery.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Neoplasm, Pleural Cavity, Prognosis, Metastasis, Epithelioid, Calretinin.

Related studies

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• Occupational exposures to asbestos, polycyclic aromatic hydrocarbons and solvents, and cancers of the oral cavity and pharynx: a quantitative literature review — S. Paget-Bailly, D. Cyr, et al. (2012)
• First case report of malignant peritoneal mesothelioma and oral verrucous carcinoma in a patient with a germline PTEN mutation: a combination of extremely rare diseases with probable further implications — M.W. Löffler, J. Steinhilber, et al. (2018)
• Solitary fibrous tumor of the buccal mucosa: report of a case with immunohistochemical studies — S. Iwai, M. Nakazawa, et al. (1999)
• Malignant mesothelioma metastatic to the oral region and latest topics (Review) — Y. Ohnishi, T. Fujii, et al. (2020)
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