Ranula or unusual metastasis of a gastrointestinal tumor?

Introduction Oral floor metastases are uncommon, especially with a gastointestinal primary. The diagnosis can be challenging, as misdiagnosis of a benign process can often occur.

Case Report A 73-year-old female patient presented with an indolent and slowly progressive swelling in the floor of the mouth for the past month. The patient‘s medical history reports on a multimodal therapy of pulmonary metastatic cholangiocarcinoma diagnosed 4 years ago. ENT examination revealed an elastic firm mass, covered with intact mucosa. The neck sonography showed image morphological aspects of ranula, corresponding to the MR diagnosis.Diagnostic excision biopsy of the cyst and marsupialisation of Wharton’s duct on the left was performed. Due to histopathologically abnormal cells and increasing tumor markers a complete excision of the anterior floor of the mouth via transcervical pull-through technique and defect reconstruction using radial forearm flap was performed. Histological examination confirmed the suspected diagnosis of a metastasis of the known cholangiocarcinoma. The surgical concept was completed by adjuvant radiotherapy. The tumour markers have reached the normal range during the course. The patient has been tumour-free for 13 months.

Conclusion Metastasis is an important differential diagnosis for patients presenting with a new head or neck lesion in the setting of a history of gastrointestinal cancer. A complete excision of the mass and determination of tumor markers are recommended for accurate differentiation.

Publication History

Article published online:
12 May 2023