A 63-year-old male patient presented with an ulcer in the gingiva adhered to the left upper molar region of one month of evolution and who had not stopped conservative treatment.
Oral examination revealed an ulcer at the level of the left upper molar area, with necrotic background and raised erythematous edges of 2 cm in diameter larger, together with an upper left vestibular fold and hard palate.
He was not a smoker or drinker and reported having undergone surgery for esophageal adenocarcinoma of 1/3 distal for four months.
It was an enteroid-type adenocarcinoma of the esophagus, poorly differentiated, with high persistence of periesophageal adipose tissue, with little fibroblastic and peritumoral lymphoid reaction, as well as lymph node metastasis, presenting intense mitotic extension, a index.
The patient did not receive chemotherapy or postoperative radiotherapy because in the immediate postoperative period she suffered from gastroesophageal suture dehiscence and gastrocutaneous fistula that resolved after parenteral nutrition.
A simple radiological study was performed by orthopantomography and Waters, showing an osteolysis image at the level of the left maxillary bone and occupation image in the left maxillary sinus.
Biopsy of the intraoral lesion was taken, informing the pathologist of metastasis of esophageal adenocarcinoma.
The patient was admitted to hospital to rule out the presence of more metastases and to delimit the extension of the metastasis of the maxillary bone.
Cervical examination to assess the status of lymph node chains was negative.
An orofacial CT scan was performed, assessing the left upper jaw with involvement of the hard palate, pterygoid apophysis, left maxillary sinus, posterior wall, and left maxillary sinus with disruption of the left maxillary floor and space.
Abdominal ultrasound and simple chest X-ray were performed and reported as normal.
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The study was completed with bone scintigraphy, showing bone lesions suggestive of malignancy in the left upper jaw bone, right pelvis, dorsal vertebra and right costal pair.
At the end of the study (two weeks since the first consultation and intraoral biopsy), the intraoral lesion had grown enormously, presenting necrotic areas and affecting the entire left vestibular fundus functional hard.
The patient died due to oral cavity effusion after massive bleeding.
