Gum Bleeding as an Unusual Initial Manifestation of Carcinoma Oesophagus: A Case Report

Abstract

Bone marrow metastasis from solid tumours typically occurs in advanced disease stages and rarely presents as the initial clinical manifestation. Herein, we are reporting that a 65-year-old man was admitted with a history of gum bleeding during dental work. His medical history was reviewed, revealing clinical signs such as pallor and gum hypertrophy. Blood tests showed anaemia, leucocytosis, thrombocytopenia, and abnormal coagulation parameters. Based on these findings, a blood disorder was suspected, leading to a bone marrow examination. Unexpectedly, the marrow showed signs of metastatic deposits. To locate the primary tumour, a whole-body FDG PET-CT scan was performed, revealing FDG-avid enlarged lymph nodes in the para-aortic, para-oesophageal, and perigastric regions, as well as multiple abdominal lymph nodes. This case is presented to clinicians to highlight the importance of understanding metastatic patterns. The presentation posed a diagnostic challenge due to its rarity. Despite being metastatic initially, the tumour responded favourably because it harboured a targetable mutation. Recent advances in oncology indicate that a poor prognosis for metastatic disease is no longer inevitable if a targetable mutation is present.