Effect of jejunal feeding tube placement on complications after laparoscopic radical surgery in patients with incomplete pyloric obstruction by gastric antrum cancer / 中华胃肠外科杂志

Objective: To assess the effect of jejunal feeding tube placement on early complications of laparoscopic radical gastrectomy in patients with incomplete pyloric obstruction by gastric cancer. Methods: This was a retrospective cohort study. Perioperative clinical data of 151 patients with gastric antrum cancer complicated by incomplete pyloric obstruction who had undergone laparoscopic distal radical gastrectomy from May 2020 to May 2022 in the First Affiliated Hospital of Nanchang University were collected. Intraoperative jejunal feeding tubes had been inserted in 69 patients (nutrition tube group) and not in the remaining 82 patients (conventional group). There were no statistically significant differences in baseline characteristics between the two groups (all P>0.05). The operating time, intraoperative bleeding, time to first intake of solid food, time to passing first flatus, time to drainage tube removal, and postoperative hospital stay, and early postoperative complications (occurded within 30 days after surgery) were compared between the two groups. Results: Patients in both groups completed the surgery successfully and there were no deaths in the perioperative period. The operative time was longer in the nutritional tube group than in the conventional group [(209.2±4.7) minutes vs. (188.5±5.7) minutes, t=2.737, P=0.007], whereas the time to first postoperative intake of food [(2.7±0.1) days vs. (4.1±0.4) days, t=3.535, P<0.001], time to passing first flatus [(2.3±0.1) days vs. (2.8±0.1) days, t=3.999, P<0.001], time to drainage tube removal [(6.3±0.2) days vs. (6.9±0.2) days, t=2.123, P=0.035], and postoperative hospital stay [(7.8±0.2) days vs. (9.7±0.5) days, t=3.282, P=0.001] were shorter in the nutritional tube group than in the conventional group. There was no significant difference between the two groups in intraoperative bleeding [(101.1±9.0) mL vs. (111.4±8.7) mL, t=0.826, P=0.410]. The overall incidence of short-term postoperative complications was 16.6% (25/151). Postoperative complications did not differ significantly between the two groups (all P>0.05). Conclusion: It is safe and feasible to insert a jejunal feeding tube in patients with incomplete outlet obstruction by gastric antrum cancer during laparoscopic radical gastrectomy. Such tubes confer some advantages in postoperative recovery.

Helicobacter pylori and colorectal neoplasms: a concise review / Helicobacter pylori e neoplasias colorretais: revisão concisa

ABSTRACT Helicobacter pylori is the main etiological agent of all malignant tumors caused by an infectious disease. It is a major, at times dominant, factor in the pathogenesis of a large spectrum of diseases such as acute and chronic gastritis, gastric and duodenal ulcers, gastric carcinoma, and lymphoma. Epidemiological and experimental studies suggest that H. pylori chronic infection may be related to different extragastric diseases, including colorectal neoplasms. This concise review aims to explore the association of H. pylori infection with colorectal cancer and adenoma, including the recent epidemiological findings, the diagnostic methods employed to detect H. pylori and virulent factors, and the potentially involved mechanisms. Furthermore, is attempted to establish the current data integration for causal inference using the Bradford-Hill causality criteria. The weak, although global, strength of the epidemiological positive association between H. pylori infection and colonic neoplasms associated to new mechanisms postulated to explain this interaction, including intestinal dysbiosis, should stimulate future studies. Prospective confirmatory studies to establish the role of H. pylori eradication in the process of carcinogenic transformation of the colonic epithelium may define its eventual role in the treatment and prevention of colonic neoplasms.

RESUMO Helicobacter pylori é o principal agente etiológico dos tumores malignos causados por doenças infecciosas. Constitui fator importante, às vezes dominante, na patogênese de um amplo espectro de doenças como gastrite aguda e crônica, úlceras gástricas e duodenais, carcinoma gástrico e linfoma. Estudos epidemiológicos e experimentais sugerem que a infecção crônica por H. pylori pode estar relacionada a diferentes doenças extragástricas, incluindo neoplasias colorretais. Esta concisa revisão tem como objetivo explorar a associação da infecção por H. pylori com câncer colorretal e adenoma, incluindo os recentes achados epidemiológicos, os métodos de diagnóstico empregados para detectar H. pylori e seus fatores de virulência com os mecanismos potencialmente envolvidos nesta relação. Além disso, procura-se estabelecer a integração dos dados atuais na busca de inferência causal com o emprego dos critérios de causalidade de Bradford-Hill. A associação epidemiológica positiva entre infecção por H. pylori e neoplasias do cólon embora classificada como fraca - porém global - do ponto de vista epidemiológico, quando associada a mecanismos recentemente postulados para explicar essa interação, incluindo disbiose intestinal, deverá estimular a realização de investigações futuras. Estudos prospectivos confirmatórios para estabelecer o papel da erradicação do H. pylori no processo de transformação carcinogênica do epitélio do cólon são aguardados para definir seu eventual papel no tratamento e prevenção de neoplasias do cólon.

Risk factors for gastric cancer: a large-scale, population-based case-control study / 中华医学杂志(英文版)

BACKGROUND@#Early detection of gastric cancer (GC) has been the topic of major efforts in China. This study aimed to explore the risk factors associated with GC and to provide evidence for the selection of a high-risk population of GC.@*METHODS@#Based on the cancer screening cohort of the National Cancer Screening Program in Urban China, GC patients diagnosed by endoscopy and pathological examinations constituted the case group, and controls were 1:3 matched by sex and age (±5 years) individually. The variables were selected by univariable analysis of factors such as body mass index (BMI), dietary habits, lifestyle, stomach disease history, and family history of GC; and multivariable logistic regression was used to analyze the influencing factors of GC and to calculate the odds ratio (OR) of related factors and its 95% confidence interval (CI).@*RESULTS@#A total of 215 GC cases and 645 matched healthy controls were included in the final analysis, with a median age of 61 years for the case and control groups. Overall analysis showed that high educational level (above primary school) (OR = 0.362, 95% CI = 0.219-0.599, P < 0.001), overweight/obesity (BMI ≥24 kg/m2; OR = 0.489, 95% CI = 0.329-0.726, P < 0.001), cigarette smoking (OR = 3.069, 95% CI = 1.700-5.540, P < 0.001), alcohol consumption (OR = 1.661, 95% CI = 1.028-2.683, P = 0.038), history of stomach disease (OR = 6.917, 95% CI = 4.594-10.416, P < 0.001), and family history of GC in first-degree relatives (OR = 4.291, 95% CI = 1.661-11.084, P = 0.003) were significantly correlated with the occurrence of GC. Subgroup analyses by age and gender indicated that GC risk was still increased in the presence of a history of stomach disease. A history of chronic gastritis, gastric ulcer, or gastric polyposis was positively associated with GC, with adjusted ORs of 4.155 (95% CI = 2.711-6.368), 1.839 (95% CI = 1.028-3.288), and 2.752 (95% CI = 1.197-6.326).@*CONCLUSIONS@#Subjects who smoke, drink, with history of stomach disease and family history of GC in first-degree relatives are the high-risk populations for GC. Therefore, attention should be paid to these subjects for GC screening.

Clinicopathological and molecular characteristics of Epstein-Barr virus associated gastric cancer: a single center large sample case investigation / 北京大学学报(医学版)

OBJECTIVE@#Epstein-Barr virus associated gastric cancer (EBVaGC) is different from the traditional gastric cancer (Epstein-Barr virus non-associated gastric cancer, EBVnGC), and has unique clinicopathological features. This study investigated the largest single center cancer series so as to establish the clinicopathological and molecular characteristics of EBVaGC in China.@*METHODS@#A retrospective analysis was conducted on EBVaGC and EBVnGC patients diagnosed at Peking University Cancer Hospital from 2003 to 2018 by comparing their clinicopathological features and prognosis. The gastric cancer (GC) dataset of public database was analyzed to obtain differentially expressed genes. The expression of important genes and their association with prognosis of GC were verified in GC tissues from our hospital.@*RESULTS@#In this study, 3 241 GC patients were included, and a total of 163 EBVaGC (5.0%) patients were identified. Compared with EBVnGC, EBVaGC was higher in male and younger patients, and positively associated with remnant GC, poorly differentiated adenocarcinoma, and mixed type GC. EBVaGC was inversely related to lymph node metastasis. The 5-year survival rate of EBVnGC and EBVaGC was 59.6% and 63.2% respectively (P<0.05). In order to explore molecular features of EBVaGC, the Cancer Genome Atlas (TCGA) dataset was analyzed (n=240), and 7 404 significant differentially expressed genes were obtained, involving cell proliferation, apoptosis, invasion and metastasis. The down-regulated invasion/metastasis gene SALL4 and the up-regulated immune checkpoint gene PD-L1 were important molecular features of EBVaGC. Validation of these two genes in large GC series showed that the majority of the EBVaGC was SALL4 negative (1/92, 1.1%, lower than EBVnGC, 303/1 727, 17.5%), and that PD-L1 was mostly positive in EBVaGC (81/110, 73.6%, higher than EBVnGC, 649/2 350, 27.6%). GC patients with SALL4 negative and PD-L1 positive were often associated with better prognosis.@*CONCLUSION@#EBVaGC is a unique subtype of GC with less metastasis and a good prognosis. It also has a distinct molecular background. The down-regulation of invasion/metastasis gene SALL4 and up-regulation of immune checkpoint gene PD-L1 are important molecular features.

Cancer patients with oral mucositis: challenges for nursing care / O paciente oncológico com mucosite oral: desafios para o cuidado de enfermagem / El paciente oncológico con mucositis oral: desafíos para el cuidado de enfermería

OBJECTIVE: to analyze nursing care provided to cancer patients with oral mucositis based on the Nursing Process (NP). METHOD: this exploratory, descriptive, cross-sectional and quantitative study was conducted with 213 patients undergoing chemotherapy and/or radiotherapy in two cancer facilities: one philanthropic and one private service. RESULTS: the participants were mainly female, aged 45.8 years old on average, with up to 11 years of schooling and income of up to one times the minimum wage. Severe mucositis was related to chemotherapy associated with radiotherapy. Only 25.3% of the patients reported having received guidance from nurses during their treatment concerning self-care. The perceptions of patients regarding quality of care did not significantly differ between the private and public facilities. The basic human needs mainly affected were comfort, eating, and hygiene. Based on this finding, one NP was established listing the diagnoses, interventions and expected results to establish an ideal, though individualized, standard of nursing care to be provided to these patients. CONCLUSION: to understand oral mucositis is crucial to establish nursing care that includes prevention based on the implementation of an oral care plan. .

OBJETIVO: analisar o cuidado de enfermagem ao paciente oncológico com mucosite oral, pautado no Processo de Enfermagem (PE). MÉTODO: estudo exploratório descritivo, transversal e quantitativo, realizado com 213 pacientes submetidos à quimioterapia e/ou radioterapia em dois serviços de oncologia, um filantrópico e outro privado. RESULTADOS: os sujeitos eram majoritariamente do sexo feminino, com média de idade de 45,8 anos, possuíam até 11 anos de estudo e renda básica de até um salário mínimo. As formas graves de mucosite detectadas relacionaram-se à quimiorradiação. Somente 25,3% dos pacientes relevaram ter recebido orientações de enfermeiros durante o tratamento e sem, conforme concepção dos pacientes, diferença significativa na qualidade da assistência de enfermagem entre serviços públicos e privados. As principais necessidades humanas básicas afetadas nos pacientes relacionaram-se aos componentes conforto, alimentação e higiene. A partir disso, delimitou-se um PE elencando diagnósticos, intervenções e resultados esperados, a fim de se estabelecer um padrão ideal, porém individualizante, de assistência de enfermagem a estes pacientes. CONCLUSÃO: conhecer a afecção mucosite oral é precípuo para formulação de uma assistência de enfermagem que vislumbre a prevenção, a partir da instituição de um plano de cuidados orais. .

OBJETIVO: analizar el cuidado de enfermería para el paciente oncológico con mucositis oral, guiado por el Proceso de Enfermería (PE). MÉTODO: estudio exploratorio descriptivo, transversal y cuantitativo, realizado con 213 pacientes sometidos a quimioterapia y/o radioterapia en dos servicios de oncología, uno filantrópico y el otro privado. RESULTADOS: los sujetos eran en su mayoría del sexo femenino, con promedio de edad de 45,8 años, poseían hasta 11 años de estudio y renta básica de hasta un salario mínimo. Las formas graves de mucositis detectadas se relacionaron a la quimiorradiación. Solamente 25,3% de los pacientes relevaron haber recibido orientaciones de enfermeros durante el tratamiento y sin, conforme concepción de los pacientes, diferencia significativa en la calidad de la asistencia de enfermería entre servicios públicos y privados. Las principales necesidades humanas básicas afectadas en los pacientes se relacionaron a los componentes confort, alimentación e higiene. A partir de eso, se delimitó un PE incluyendo diagnósticos, intervenciones y resultados esperados, con la finalidad de establecer un estándar ideal, sin embargo individualizado, de asistencia de enfermería para estos pacientes. CONCLUSIÓN: conocer la enfermedad mucositis oral es primordial para la formulación de una asistencia de enfermería que objetive la prevención, a partir de la institución de un plan de cuidados orales. .

Unpleasant Journey from Helicobacter pylori-associated Gastritis to Gastric Cancer: Cancer Prevention by Taking a Detour / 대한소화기학회지

As a commensal or a pathogen, Helicobacter pylori can change the balance of a complex interaction that exists among gastric epithelial cells, microbes, and their environment. Therefore, unraveling this complex relationship of these mixtures can be expected to help prevent cancer as well as troublesome unmet medical needs of H. pylori infection. Though gastric carcinogenesis is a multi-step process, precancerous lesion can be reversible in the early phase of mucosal damage before reaching the stage of no return. However, biomarkers to predict rejuvenation of precancerous atrophic gastritis have not been identified yet and gastric cancer prevention is still regarded as an impregnable fortress. However, when we take the journey from H. pylori-associated gastritis to gastric cancer, it provides us with the clue for prevention since there are two main preventive strategies: eradication and anti-inflammation. The evidence supporting the former strategy is now ongoing in Japan through a nation-wide effort to eradicate H. pylori in patients with chronic gastritis, but suboptimal apprehension to increasing H. pylori resistance to antibiotics and patient non-compliance still exists. The latter strategy has been continued in the author's research center under siTRP (short-term intervention to revert premalignant lesion) strategy. By focusing on the role of inflammation in the development of H. pylori-associated gastric carcinogenesis, this review is intended to explain the connection between inflammation and gastric cancer. Strategies on H. pylori eradication, removal of inflammation, and reverting preneoplastic lesion will also be introduced. In the end, we expect to be able to prevent gastric cancer by take a detour from the unpleasant journey, i.e. from H. pylori-associated gastritis to gastric cancer.

Changes in Upper Gastrointestinal Diseases according to Improvement of Helicobacter pylori Prevalence Rate in Korea / 대한소화기학회지

Helicobacter pylori can cause variety of upper gastrointestinal disorders such as peptic ulcer, mucosa associated lymphoid tissue (MALT)-lymphoma, and gastric cancer. The prevalence of H. pylori infection has significantly decreased in Korea since 1998 owing to active eradication of H. pylori. Along with its decrease, the prevalence of peptic ulcer has also decreased. However, the mean age of gastric ulcer increased and this is considered to be due to increase in NSAID prescription. Gastric cancer is one of the leading causes of cancer deaths in Korea and Japan, and IARC/WHO has classified H. pylori as class one carcinogen of gastric cancer. Despite the decreasing prevalence of H. pylori infection, the total number of gastric cancer in Korea has continuously increased from 2006 to 2011. Nevertheless, the 5 year survival rate of gastric cancer patients significantly increased from 42.8% in 1993 to 67% in 2010. This increase in survival rate seems to be mainly due to early detection of gastric cancer and endoscopic mucosal dissection treatment. Based on these findings, the prevalence of peptic ulcer is expected to decrease even more with H. pylori eradication therapy and NSAID will become the main cause of peptic ulcer. Although the prevalence of gastric cancer has not changed along with decreased the prevalence of H. pylori, gastric cancer is expected to decrease in the long run with the help of eradication therapy and endoscopic treatment of precancerous lesions.

Concurrent Gastric and Pulmonary Mucosa-Associated Lymphoid Tissue Lymphomas with Pre-Existing Intrinsic Chronic Inflammation: A Case Report and a Review of the Literature

Herein, we report a rare case of concurrent gastric and pulmonary mucosa-associated lymphoid tissue (MALT) lymphomas. A 65-year-old man who had been diagnosed with Helicobacter pylori-positive gastric MALT lymphoma received eradication therapy and achieved complete remission. During follow-up, he developed de novo pulmonary MALT lymphoma as a sequela of pulmonary tuberculosis, accompanied by recurrent gastric MALT lymphoma. Polymerase chain reaction (PCR) products of the CDR3 region of the immunoglobulin heavy chain gene showed an overall polyclonal pattern with bands at 400 base pairs (bp) and 200 bp predominant in the pulmonary tissue, as well as two distinctive bands in the gastric tissue at 400 bp and 200 bp. This case suggests that multiorgan lymphomas are more likely to be independent from each other when they are far apart, involve different organ systems, and have independent precipitating factors.

Concurrent Gastric and Pulmonary Mucosa-Associated Lymphoid Tissue Lymphomas with Pre-Existing Intrinsic Chronic Inflammation: A Case Report and a Review of the Literature

Herein, we report a rare case of concurrent gastric and pulmonary mucosa-associated lymphoid tissue (MALT) lymphomas. A 65-year-old man who had been diagnosed with Helicobacter pylori-positive gastric MALT lymphoma received eradication therapy and achieved complete remission. During follow-up, he developed de novo pulmonary MALT lymphoma as a sequela of pulmonary tuberculosis, accompanied by recurrent gastric MALT lymphoma. Polymerase chain reaction (PCR) products of the CDR3 region of the immunoglobulin heavy chain gene showed an overall polyclonal pattern with bands at 400 base pairs (bp) and 200 bp predominant in the pulmonary tissue, as well as two distinctive bands in the gastric tissue at 400 bp and 200 bp. This case suggests that multiorgan lymphomas are more likely to be independent from each other when they are far apart, involve different organ systems, and have independent precipitating factors.

Sarcoma de Kaposi gástrico en un paciente con virus de inmunodeficiencia humana (VIH) / Gastric Kaposi Sarcoma in a patient with HIV

Hombre de 38 años que consultó por sangrado digestivo de dos días de duración. La esofagogastroduodenoscopía demostró múltiples lesiones nodulares de color púrpura en el antro gástrico. La histopatología mostró un tumor formado por células fusiformes y proliferación vascular, hallazgos consistentes con sarcoma de Kaposi del estómago. Posteriormente se determinó la infección por virus de inmunodeficiencia (VIH) del paciente.

A 38 years old man with 48 hours of gastrointestinal bleeding was admitted to the hospital. The EGD revealed red-purple nodules in the gastric antrum. Histopathologically, there were spindle cells and capillary size vascular proliferation. These findings were consistent with Kaposi sarcoma of the stomach. Immediately after, the patient had a positive test for HIV.

Sarcoma, Kaposi; Gastric antrum; HIV.

Tendências da incidência e da Mortalidade do câncer de estômago no município de São Paulo / Trends in stomach cancer incidence and mortality in Sao Paulo

O câncer de estômago já foi, mundialmente, a neoplasia com maior ocorrência na população. Ao longo das décadas, a incidência deste câncer apresenta tendência de decréscimo significativo, sendo que, atualmente, é o quinto tumor maligno mais frequente no mundo. A mortalidade não acompanhou a tendência de decréscimo na mesma velocidade e ainda é considerada a terceira principal causa de morte por câncer. O Brasil acompanhou a tendência mundial, registrando o declínio significativo da incidência e da mortalidade. O município de São Paulo apresenta as mais altas taxas de incidência e mortalidade do país. Apesar disso, existem poucos estudos de tendências de incidência dessa neoplasia para São Paulo e este é o primeiro estudo que investiga as tendências de incidência e mortalidade por sexo, por faixas etárias e por tipo histológico. OBJETIVO: analisar as tendências dos coeficientes de incidência e mortalidade do câncer de estômago, segundo sexo, faixa etária e tipo histológico pela classificação de Lauren. MÉTODOS: estudo ecológico de séries temporais. Foram analisados os novos casos de câncer de estômago, diagnosticados no período de 1997 a 2011, no município de São Paulo, cadastrados no Registro de Câncer de Base Populacional de São Paulo, e os óbitos por câncer de estômago do período de 1980 a 2011, de residentes no Município de São Paulo, obtidos do site do Departamento de Informática do Sistema Único de Saúde (DATASUS) do Ministério da Saúde. Foram feitas análises...

The stomach cancer was once considered as the most incident neoplasm worldwide. Over the decades, the stomach cancer incidence has been showing a significant decreasing trend, and is currently the fifth most common malignancy in the world. Mortality has not followed this decreasing trend at the same speed and is still considered the third leading cause of cancer death. Brazil follows this global trend, having a significant decline both in incidence and mortality. Across the regions of Brazil, the city of São Paulo has one of the highest incidence and mortality rates. Nevertheless, there are few studies on trends of this neoplasm in Sao Paulo and this is the first study to investigate the trends of incidence and mortality by sex, age group and histological type. OBJECTIVE: to analyze the trends in stomach cancer incidence and mortality, according to gender, age group and histological type of Lauren/'s classification. METHODS: this is an ecological time-series study. We analyzed the new cases of stomach cancer diagnosed between 1997 and 2011 in São Paulo registered in the Population Based Cancer Registry of São Paulo and deaths from stomach cancer from 1980 to 2011, in the city of São Paulo, obtained from the Ministry of Health website - Department of the Unified Health System (DATASUS). Time series analyzes were performed by gender, age group and histological type using the Lauren classification of intestinal-type and diffuse type. Crude and agestandardized...

Late administration of a specific COX-2 inhibitor does not treat and/or prevent progression of gastric tumors in rats submitted to duodenogastric reflux procedure

PURPOSE:To assess whether late introduction of a specific COX-2 inhibitor (Meloxicam) can treat and/or prevent the progression of tumors in the stomach of rats submitted to duodenogastric reflux. METHODS: Seventy five male Wistar rats, weighing 150 grams, were submitted to the induction of duodenogastric reflux through the pylorus. At 36 weeks of follow-up were established three experimental groups: DGR36 sacrificed immediately, DGR54 and DGR54MLX both sacrificed at 54th week of follow-up . The animals of the latter group were fed with a rat chow premixed with Meloxicam (2.0 mg/ kg feed; 0.3 mg / kg bw / day) and the other two with standard rat chow. The lesions found in the pyloric mucosa and gastrojejunal anastomosis were analyzed macroscopically and histologically. For statistical analysis was adjusted a generalized linear model assuming a binomial distribution with LOGIT link function. RESULTS: No significant differences were found when comparing the incidences of benign tumor lesions (Adenomatous Hyperplasia), p=0.4915, or malignant (Mucinous Adenocarcinoma), p=0.2731, among groups. CONCLUSION: Late introduction of specific COX-2 inhibitor (Meloxicam) did not treat and was not able to prevent the progression of tumoral lesions induced by duodenogastric reflux in the rat stomachs.

Controversias entre la infección por Helicobacter pylori y la epidemiología del cáncer gástrico / Helicobacter pylori infection and the epidemiology of gastric malignancy

Se cree que la infección por Helicobacter pylori se asocia con la aparición de cáncer gástrico. De hecho, varios estudios han postulado, probado y supuestamente demostrado esta asociación. Desafortunadamente, muchos de estos estudios han arrojado resultados contradictorios. Al parecer, en algunas ocasiones existe una asociación sólida, pero en otras oportunidades no queda claro si esto es así. Al menos el 50% de todos los estudios destinados a demostrar esta asociación han observado una asociación negativa entre esta bacteria y el cáncer gástrico. Incluso aquellos que han logrado resultados con asociación positiva no son reproducibles, lo que sugiere una falta de congruencia. Por otra parte, los datos epidemiológicos son insuficientes para demostrar la causalidad por sí mismos. Tan es así que los experimentos que se han realizado en animales para establecer un vínculo claro entre la infección y el cáncer gástrico no han sido muy exitosos. Por ende, en la actualidad, Helicobacter pylori no parece tener una asociación de tipo “causa y efecto” con el cáncer gástrico. Creemos que la clasificación de este patógeno por la AIIC en 1994 dentro del grupo de los carcinógenos humanos del grupo 1 fue prematura, y que se justifica realizar una reclasificación de esta bacteria en una categoría más apropiada, debido a la falta de pruebas firmes.

Presentación de doble metástasis en territorio máxilo facial: reporte de caso clínico / Double presentation metastasis maxillofacial territory: clinical case report

El presente reporte de caso describe una presentación atípica de metástasis mandibular y cerebral con tumor primario desconocido. Un paciente de sexo masculino de 72 años de edad, presenta aumento de volumen mentoniano de 2 meses de evolución, sin compromiso cutáneo, que apareció simultáneo a tratamiento de exodoncias múltiples. Refiere episodios de remisión respondiendo a tratamiento antibiótico oral. Los estudios inmunohistoquímicos indican que la lesión mandibular es compatible con metástasis de cáncer gástrico, páncreas o vía biliar. Durante el estudio se encuentra por medio del TAC una lesión cerebral correspondiente a metástasis. Este artículo pretende realizar una revisión de la literatura disponible sobre estudio inmunohistoquímico para diagnóstico diferencial de lesiones compatibles con metástasis, frecuencia de los tumores primarios que dan metástasis mandibulares y cuales son los criterios clínicos y la conducta a seguir para su tratamiento.

About 1% of all carcinoma of the oral cavity are metastases of primary tumors elsewhere in the body. Jaw's cancer usually presents in a manner that its clinical characteristics may help the surgeon to recognize it or when the primary tumor has already been diagnosed or even treated. This article shows an atypical presentation of Jaw's cancer without osseous involvement in which during the study with CT scan we found a cerebral lesion that was a metastasis. However studies with immunohistochemistry showed that the Jaw's cancer wasn't the primary tumor.The aim of this article is to review the literature to study by prevalence which could have been the primary tumor that produced both types of metastases, the clinical criteria and the conduct that must be followed for the treatment.