Oral medicine
Online only article
Oral presentation of malignant mesothelioma

This case was presented as an oral presentation at the annual meeting of the British Society for Oral Medicine in Cork, Eire (Ireland), May 13-15, 2009, under different authorship (J. H. Higham, M. H. Thornhill, G. T. Craig, A. T. Rendon).
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We report a case of metastatic mesothelioma presenting as an oral metastasis in a 46-year-old patient. The patient presented with 2 polypoid lesions that appeared to be benign on the dorsum of the tongue. Excisional biopsy showed the presence of metastatic carcinoma that on further investigation proved to be mesothelioma. The initial presentation of mesothelioma as an oral metastasis is not previously reported. This article highlights the importance of biopsy and histopathological diagnosis in presumed benign lesions and the role of the general dental practitioner in screening for oral neoplasms.

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Clinical Presentation

A 46-year-old, otherwise fit and well female patient, presented to her dental practitioner for a routine dental examination. The dentist noted a 10 × 5-mm firm nodular swelling on the left posterior dorsum of the tongue. The patient had been aware of the lump for 8 months but it had not caused any pain or discomfort. The dentist referred the patient to the Department of Oral Medicine at the Charles Clifford Dental Hospital for investigation and management. In the 2 weeks before being seen in

Differential Diagnosis

The clinical appearance was most suggestive of a fibroepithelial polyp but within the differential diagnosis were other benign tumors of the oral mucosa including giant cell fibroma, lipoma, myxoma, neurofibroma, schwannoma, leiomyoma, and granular cell tumor, and because of the papillary surface, papilloma or verruciform xanthoma had to be considered although the papillae were closely similar to, and more suggestive of, the normal filliform papillae of the dorsal lingual mucosa. The lesions

Diagnosis

At low power (Fig. 1, A) the histology was superficially similar to that of a fibroepithelial polyp, but at high power (Fig. 1, B) histological examination revealed unremarkable stratified squamous epithelial tissue of the tongue with widespread infiltration of the underlying connective tissue by a mildly pleomorphic epithelioid neoplasm. The tumor was composed of bland epithelioid/cuboidal cells arranged in solid sheets and with some glandularlike areas. Eosinophilic cytoplasm and well-defined

Management

The diagnosis of mesothelioma raised questions as to whether the patient had had previous asbestos exposure, as most mesotheliomas in the United Kingdom have such exposure. On further questioning, the patient could not recall any such event. However, from about the age of 15 she had worked for a period of about 8 years as a cleaner in old hospital and school buildings that may have contained asbestos. She gave no history of any household contacts with occupational exposure to asbestos.

Following

Discussion

More than 90% of malignant oral tumors are primary squamous cell carcinomas.4 Metastases in the oral region are uncommon and represent only 1% of all malignant oral lesions.2 These lesions therefore often present a diagnostic challenge, as it must first be recognized that the lesion may originate from somewhere outside the oral region. Second, the site of origin of the primary lesion must be identified so that further investigation and treatment can be targeted appropriately. Interestingly, in

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