Answer to the last #DiagnosticDilemma
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The answer to the last Diagnostic Dilemma (A 60-year-old woman presented with gum swelling. She had associated bleeding while brushing her teeth. She had a history of colorectal cancer treated with surgery and chemotherapy.) is B) Metastasis of colorectal cancer.

A 60-year-old woman presented to the oral surgery clinic with gingival swelling. She had a history of colorectal cancer, which had been diagnosed a year earlier, for which she had undergone surgery and received chemotherapy. She first noticed the mass after bleeding occurred while she was brushing her teeth. On examination, a large, non-tender, the pedunculated mass was seen extending from the buccal gingival border of the lower right second premolar to the lingual border. The surface was friable, and dental indentations on the occlusal aspect suggested chronicity. An excisional biopsy was performed, and histopathological analysis showed an infiltrating tumor, consistent with adenocarcinoma, probably of colorectal origin. At a follow-up visit 2 weeks later, further debulking of the tumor was performed. Positron-emission tomography showed multiple visceral metastases. The most common sites of metastasis of colorectal adenocarcinoma are the liver and lungs; metastatic lesions in the oral cavity are unusual. The patient was enrolled in a clinical trial of a chemotherapy regimen but was eventually lost to follow-up.

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Source: NEJM
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