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105:A Rare Presentation of Metastatic Adenocarcinoma of the Lip[AAOM2021]
EP36058
Poster Title: 105:A Rare Presentation of Metastatic Adenocarcinoma of the Lip[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Roopali Kulkarni, Faizan Alawi, Eric T. Stoopler, Thomas P. Sollecito, Takako I. Tanaka
Affiliations: University of Pennsylvania, United States of America
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 50
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Poster Information
Abstract: Background: Adenocarcinoma is the most common form of colorectal cancer, representing greater than 95% of all cases. Metastases of colorectal adenocarcinoma represent less than 1% of all oral malignant tumors. Its involvement in the oral mucosa is less frequent than in the jawbone (2.5:1).

Case summary: A 54-year-old male patient presented to the Oral Medicine clinic at the Hospital of the University of Pennsylvania for evaluation of a painless bump on his lower lip. The patient reported the lesion was slowly growing over the past three months and led to occasional lip biting. He denied any bleeding or discharge from the area. Past medical history included stage IV colorectal adenocarcinoma diagnosed three years prior with subsequent recurrence and recent metastasis to bone and lungs, for which he was undergoing systemic chemotherapy with capecitabine-oxaliplatin. Social, family, and surgical history were noncontributory. Extraoral examination findings were unremarkable. Intraoral examination revealed a 1.5 x 2 cm submucosal, well-demarcated nodule on the lower right labial mucosa. The lesion felt firm, fixed, and somewhat lobed. An incisional biopsy of the lesion was performed, and microscopic analysis revealed mucosa overlying connective tissue containing islands and cords of poorly differentiated malignant cells, with scattered individually infiltrating tumor cells. The neoplastic cells contained hyperchromatic, markedly pleomorphic nuclei and there were numerous mitoses. Glandular differentiation was identified in scattered areas throughout the tumor. The diagnosis was poorly differentiated adenocarcinoma consistent with metastatic colorectal adenocarcinoma. The patient was advised to follow up with oncology for further evaluation and subsequently, chemoradiation therapy was implemented. At most recent follow-up, the patient described the lip lesion as unnoticeable.

Conclusions: Although rare, metastatic adenocarcinomas may present as asymptomatic nodules in the oral cavity. Timely diagnostic work-up and appropriate referral are key in the management of patients because such lesions typically indicate widespread disease and poor prognosis. This case exemplifies the importance of interdisciplinary collaboration between oral medicine and oncology
Summary: Adenocarcinoma is the most common form of colorectal cancer, representing greater than 95% of all cases. Metastases of colorectal adenocarcinoma represent less than 1% of all oral malignant tumors. Its involvement in the oral mucosa is less frequent than in the jawbone (2.5:1).

Ask the author questions about this poster:roopalik@upenn.edu
References: 1. Thrumurthy SG, Thrumurthy SSD, Gilbert CE, Ross P, Haji A. Colorectal adenocarcinoma: risks, prevention and diagnosis. BMJ. 2016 Jul 14;354.
2. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019 Oct 19;394:1467-80.
3. Lee JI, Lee YH. Metastatic carcinoma of the oral region: An analysis of 21 cases. Med Oral Patol Oral Cir Bucal. 2017 May;22(3):e359-65.
4. Neumann ED, Vintro XL, Garcia CV, Agusti MQ. Oral cavity colon adenocarcinoma metastases: Case report with surgical approach and review of more than 30 years literature. Oral Maxillofac Surg. 2020 Jul 28.
5. Romanet I, Lan R, Ordioni U, Albertini AF, Campana F. A rare case of oral metastasis of colon adenocarcinoma. J Stomatol Oral Maxillofac Surg. 2018 June;119(3):229-31.
6. Guimaraes DM, Pontes FSV, Miyahara LAN, et. al. Metastatic renal cell carcinoma to the oral cavity. J Craniofac Surg. 2016 Sep;27(6):e533-4.
7. Marano AA, Therattil PJ, Viviano SL, Datiashvili RO.
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