Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
Oral medicineOnline only articleOral presentation of malignant mesothelioma
Section snippets
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
References (36)
- et al.
Metastatic mesothelioma of the oral cavityReport of two cases
Oral Surg Oral Med Oral Pathol
(1993) - et al.
Positron emission tomography with F18-fluorodeoxyglucose in the staging and preoperative evaluation of malignant pleural mesothelioma
J Thorac Cardiovasc Surg
(2000) - et al.
Integrated computed tomography-positron emission tomography in patients with potentially respectable malignant pleural mesothelioma: staging implications
J Thorac Cardiovasc Surg
(2005) - et al.
Tongue metastasis from a malignant diffuse mesothelioma of the pleura: report of a case
J Oral Maxillofac Surg
(1999) - et al.
Skeletal muscle metastasis from malignant pleural mesothelioma
Clin Oncol
(2004) - et al.
Cerebral metastases in malignant mesothelioma: case report and literature review
J Clin Neurosci
(2004) - et al.
Unusual metastases from malignant pleural mesothelioma
Clin Oncol
(2005) UK oral cancer statistics
- et al.
Metastatic tumors to the oral cavity—pathogenesis and analysis of 673 cases
Oral Oncol
(2008) Mouth, secondary nodes of the neck, tonsil, nasopharynx, paranasal sinuses, ear, salivary glands