metastatic tumors in the oral cavity are uncommon . review of the literature revealed only 63 cases of gingival soft - tissue metastases . metastasis to the jaw bones is much more common than oral soft - tissue , most common site being the mandible ( 82 - 90% ) followed by the maxilla ( 10 - 20% ) and the metastases to perioral soft - tissue accounts for only 15% of cases . they usually occur as gingival hyperplastic or reactive lesions with the clinical appearance of pyogenic granuloma or epulis , lesions with which they can be confused , even with the possibility of being multiple and bilateral . seventy percent of oral metastases are manifested after the primary tumor becomes evident while the remaining 30% are the first clinical sign of the tumor . fifty percent of all oral metastases are caused by tumors from breast , lung , and kidney . the remaining are located in prostate , thyroid , gastrointestinal tract ( mainly seen in japanese ) , suprarenal , uterus , bones etc . the mean age of occurrence is 5 and 6 decades though it may occur at any age . there are no significant differences regarding sex ; however , it is clear that the primary tumors vary depending on the sex . the occurrence of a metastatic lesion to the oral cavity is generally associated with poor prognosis having median survival of 6 months . a 60-year - old male patient , known case of adenocarcinoma of gastroesophageal ( ge ) junction on chemotherapy , presented with a soft exophytic swelling over gingiva of right lower jaw in the first and second pre - molar space . oral examination showed a soft swelling measuring 3 cm  2 cm covered by necrotic tag . the swelling resembled periodontal pyogenic abscess or granuloma like hyperplastic lesion [ figure 1 ] . computed tomography scan revealed a growth at ge junction [ figure 2 ] , which was reported as adenocarcinoma on histopathology [ figure 3 ] . patient was put on chemotherapy . clinical photograph of gingival growth computed tomography scan showing gastroesophageal junction growth biopsy from the gastroesophageal junction growth , showing adenocarcinoma ( h and e , 400 ) biopsy from the gingival mass was taken . grossly , we received three tiny pieces of grey white tissue , which were submitted entirely . microscopy revealed a tumor composed of cuboidal to columnar cells having pleomorphic vesicular nuclei with prominent nucleoli and a moderate amount of eosinophilic to clear cytoplasm arranged predominantly in papillary and focally in acinar pattern . hence the diagnosis of metastatic adenocarcinoma was confirmed . following this , the patient received one cycle of local radiotherapy . biopsy from gingival growth with similar histomorphological features as figure 3 ( h and e , 400 ) metastasis to the oral cavity is very rare accounting for about 1% of all oral tumors and metastasis to oral soft - tissue is still rarer . in the oral cavity though any site may be affected , the most common primary site for oral soft - tissue metastases is gingiva ( 55% ) because of its fine capillary bed followed by tongue ( 30% ) . metastasizing is a complex process , the biological basis of which requires tumor cells to breach a sequence of barriers . first , they have to detach from the primary tumor ; then they must spread in the tissue , invade the blood or lymphatic vessels and survive travel in the circulation . after this , they have to settle in the microvasculature of the organ , extravasate through the vessel wall , invade the target organ and proliferate within the target tissue . for a micro metastasis to grow beyond the size of 2 - 3 mm , tumor cells have to induce the formation of new blood vessels ( angiogenesis ) for adequate supply of oxygen and nutrients . chronically swollen gums with rich vascular neoformation must be considered in the attraction of metastatic cells since fragmented basal membrane of newly formed vessels ( neocapillaries ) can be more easily penetrated by tumor cells than mature vessels . one possible explanation for blood borne metastases to the head and neck , especially , in the absence of pulmonary metastases is batson 's plexus , a valveless vertebral venous plexus that might allow retrograde spread of tumor cells bypassing filtration through the lungs . adenocarcinoma of ge junction remains a significant clinical problem that is increasing in incidence and is associated with a poor prognosis . siewert and stain have proposed a clinical classification system , type i to iii for ge junction cancer to aid the clinicians in developing treatment strategies for this heterogenous clinical entity . type i : adenocarcinoma of the distal esophagus arising from intestinal metaplasia , i.e. , barrett 's esophagus and may infiltrate the ge junction from above . type ii : true carcinoma of the cardia arising from the cardiac epithelium or short segments with metaplasia at the ge junction . type iii : subcardial gastric carcinoma infiltrating the ge junction and distal esophagus from below . patients with type i tumors are more likely to have a hiatal hernia and a long history of gastro esophageal reflux disease than patients with type ii or iii tumor . the so called barrett 's esophagus with subsequent development of progressively severe dysplastic changes is the main precursor lesion for adenocarcinoma in the distal esophagus ( found in more than 80% of patients ) . type ii and iii tumors may also arise from short segments of intestinal metaplasia at or below the cardia ; however , it happens in less than 40% of patients with carcinoma of the cardia and in less than 10% of those with subcardial carcinoma . there is a strong association between helicobacter pylori and intestinal metaplasia at or below the gastric cardia . on the contrary , the specialized intestinal metaplasia in the distal esophagus is reflux related . the prevalence of undifferentiated tumor and tumor with a non - intestinal growth pattern is rather low in type i tumors and increases significantly from type ii to iii tumors . our patient had kept regular follow - up for 2 months and he expired 3 months after the diagnosis . the overall survival rate is poor in most patients with adenocarcinoma of ge junction because lymph node or visceral metastases are frequently present at the time patients become symptomatic . inflammatory and reactive lesions are more common in the oral soft tissue and include lesions such as pyogenic granuloma , periodontal abscess or inflammatory hyperplastic lesion making it imperative that metastases could be included in the differential diagnosis of gingival masses . most patients complain of swelling , pain or paresthesia that develop in a relatively short time . surgery is usually undertaken when the primary tumor is controlled and there is no evidence of other metastases . therefore , the clinicians should be aware of clinical and prognostic implications of oral metastatic lesions .
malignant tumors rarely metastasize to the oral cavity and account for about 1% of all oral tumors . 
 metastasis to soft - tissue of the oral cavity is much rarer than jaw bones . 
 because of the rarity , metastatic tumors in the oral region are challenging for diagnosis . 
 primary tumors which metastasize to mouth are the most commonly lung , breast , and kidney . 
 oral cavity metastases represent distant spread and are associated with poor prognosis with short survival . 
 we present a case of the gastroesophageal junction adenocarcinoma with metastasis to the oral soft - tissue .