2014 Volume 54 Issue 7 Pages 969-973
Background. Pleomorphic carcinoma is a histological subset of lung cancer in the revised classification proposed by the WHO. Pulmonary pleomorphic carcinoma is rare, representing only 0.1-0.4% of all malignant tumors of the lung, and the recommended therapy has yet to be defined. Gingival metastasis is very rare, comprising only 1-3% of oral malignant tumors. We experienced a case of metastasis of pulmonary pleomorphic carcinoma that was successfully treated with concurrent chemoradiotherapy. Case. A 76-year-old man with pain and hemorrhage in the right maxillary molar gingiva was referred to the oral and maxillofacial surgery department of our hospital. Positron emission tomography with 18-fluorodeoxy-glucose (FDG-PET) and CT revealed a nodule in the left inferior lobe and left hilar and mediastinal lymph nodes, with a high maximum standardized uptake value (SUVmax). A biopsy of the mediastinal lymph node and gingival tumor was performed for a further evaluation. The histopathological analysis indicated the presence of pulmonary pleomorphic carcinoma with gingival metastasis. In order to improve the deformity in the patient's facial appearance and relieve the pain and hemorrhage caused by the gingival metastasis, we administered palliative radiotherapy for gingival metastasis with two cycles of chemotherapy consisting of carboplatin and paclitaxel. Although the treatment dramatically improved the gingival metastasis and the patient's facial aesthetics, his general condition gradually worsened in association with progression of the mediastinal lesion and other metastases and he ultimately died 54 days after the therapeutic intervention. Conclusions. In the present case, the gingival metastasis within the irradiation field was successfully treated, whereas the primary lesion and other metastases located outside the irradiation field rapidly progressed despite the administration of chemotherapy. These results suggest that radiotherapy for gingival metastasis of pulmonary pleomorphic carcinoma is effective and subsequently improves the patient's oral function and facial aesthetics.
