Peri-Implant Metastasis as First Manifestation of an Unknown Lung Cancer: Literature Review and Two New Cases
Metastases around dental implants are extremely rare. They usually represent a secondary localization of a multiorgan metastatic neoplasm but also are, exceptionally, recognized as the first clinical manifestation of a still unknown cancer of whatever organ. Metastases usually manifest as rapidly growing lesions of hard and soft tissues and always represent a true diagnostic/therapeutic dilemma both for clinicians in choosing the more appropriate treatment and for pathologists in recognizing the primary tumor when still undiagnosed. We report 2 distinct cases of metastasis occurring around dental implants in the maxilla and mimicking peri-implantitis at the onset; more precisely, in one case, the lesion involved exclusively the alveolar bone, where an implant were previously inserted, while in the other case, a neoplasm caused bone destruction around the fixture with an impressive and rapid exophytic growth. In both cases, maxillary lesions were the first metastatic manifestation of an unknown adenocarcinoma of the lung.
(Case 1) Patient affected by chronic and diffuse periodontal disease (a); teeth were extracted and subsequently replaced by implant-supported prosthesis (b).
(Case 1) Dehiscent gingival wound after the second insertion of implants in the same area (22–25) with partially exposed fixtures, signs of bone necrosis, and infection (a); periapical (b) and panoramic (c) radiographs showing osteolysis around implants; computed tomography (d, e) with three-dimensional reconstruction (f) showing a wide osteolytic process of the palatal bone with erosion of the buccal cortical bone and maxillary sinus floor.
Histological examination showing morphological features of typical adenocarcinoma, with evident lumen formation (a, hematoxylin and eosin, ×20); immunohistochemical investigations revealed consistent cytokeratin 7 (b, ×20) and TTF-1 (c, ×20) positivity.
Chest computed tomography scan showing the primary lung adenocarcinoma.
(Case 2) Rapidly growing mass of brownish color arising from the anterior maxillary gingiva with palatal extension also incorporating teeth (a) and causing labial incontinence (b); panoramic radiograph showing a wide osteolytic lesion of the maxilla around the fixture (c); the mass was surgically reduced to improve function, and the implant was contextually removed (d).
Contributor Notes