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Jaw Bone Metastasis: Four cases
Abstract
Metastatic tumors make up approximately one percent of all oral malignancies. Such tumors may present in the jaw bones and oral soft tissues. The commonest oral site is the mandible.
This is a retrospective study of four cases of metastatic tumors of the jaws seen at the Oral-Maxillofacial Department, General University Hospital of Alexandroupolis, Thrace, Greece from 1989 to 2005, representing 1% of all histologically confirmed malignant tumors at the hospital.
Two cases originated from the thyroid gland, one was from the esophagus, and one from the liver. Three metastases occurred in the mandible and one in the maxilla. The oral symptoms were similar to odontogenic infections or to benign neoplasms.
In view of the resemblance in the presentation of metastases and other tumors affecting the jaws, a high index of clinical suspicion is advocated to ensure early, multidisciplinary care of hosts.
... FTC facial bone metastasis can present in the gnathic bones, the paranasal sinuses, or the orbit. Metastasis to the facial skeleton may be the first clinical sign of an underlying malignancy and clinical presentation varies depending on site of presentation as well as the primary site [3][4][5][6][7]. Oral cavity and maxillofacial region metastasis is uncommon and represent 1-2% of all oral and maxillofacial malignancies [3][4][5]. ...
... Metastasis to the facial skeleton may be the first clinical sign of an underlying malignancy and clinical presentation varies depending on site of presentation as well as the primary site [3][4][5][6][7]. Oral cavity and maxillofacial region metastasis is uncommon and represent 1-2% of all oral and maxillofacial malignancies [3][4][5]. Prognoses of such lesions are assumed to be poor; however, there is a paucity of evidence to guide management of these scenarios. ...
... Thyroid malignancy represents 2% of facial skeleton metastasis [20] and 4.2-6.1% of all jaw metastases [7,15,21] 41% of facial skeleton metastasis from thyroid cancer occurs in the mandible; 59% of these metastases are well-differentiated thyroid cancer. There have been 41 reported cases in the literature of thyroid malignancy with metastasis to the mandible of which 21 reported cases were FTC [4,[9][10][11][12]. There have been 6 reported cases of metastasis to the maxilla; 2 were FTC [22,[48][49][50][51][52]. ...
Background
Follicular thyroid carcinoma (FTC) metastasis to the facial skeleton is exceedingly rare. A case of FTC metastasizing to the mandible is presented and a systematic review of the literature describing thyroid metastasis to the facial skeleton is performed. Case presentationA 73-year-old female presented with metastatic FTC to the mandible and underwent total thyroidectomy, segmental mandibulectomy, bone impacted fibular free flap reconstruction, and adjuvant radioactive iodine treatment. The PubMed database was searched for literature describing thyroid cancer with facial skeleton metastasis using the key words ?thyroid,? ?cancer,? ?carcinoma,? ?metastasis,? and ?malignancy? with ?oral cavity,? ?maxilla,? ?mandible,? ?sinus,? ?paranasal,? and ?orbit.? Reports that only involved the soft tissues were excluded. Systematic review revealed 59 cases of well-differentiated thyroid cancer with facial skeleton metastasis: 35 mandibular metastases (21 = FTC), 6 maxilla metastases (2 = FTC), 9 orbital metastases (4 = FTC), and 11 paranasal sinus metastases (7 = FTC). Treatment included surgery, RAI, external beam radiotherapy (XRT), or a combination of these modalities. The one, two, and five-year survival rates were 100%, 79%, and 16%, respectively. Conclusion
Facial skeleton metastasis of FTC is a rare clinical challenge. Optimal treatment appears to include total thyroidectomy and resection of involved structures with or without adjuvant treatment.
... But metastases in the oral cavity are rarely seen and they usually spread from the primaries of breast, lungs, kidney, prostate, thyroid, etc. and their occurrences in the oral cavity are less than 1% of all the jaw tumors. [1][2][3][4] Germ cell tumors are rarely found in people and the metastases in the oral cavity from a germ cell tumor is extremely rare. Germ cell tumors are classified into germinomatous (gonadal origin) and nongerminomatous (extragonadal origin). ...
... 3 If the oral cavity metastases is the first manifestation of the disease the diagnosis can be difficult since the symptoms mimic the odontogenic infection. [2][3][4][5] Majority of the oral metastases are derived from tumors of epithelial and connective tissues only. The germ cell malignancy is serious life-threatening one and has high tendency to metastasize with bad prognosis, if neoplasm arises from the placental tissue or develops extragonadally. ...
... 3 Particular attention and knowledge, to diagnose and differentiate the oral lesion before arriving to a conclusion, is mandatory to every clinician. 2,4 It has commonly happened in majority of cases that primary tumor is left undiagnosed at the time of metastasized jaw tumor is presented and diagnosed. 5 Regarding this case, the primary carcinoma was not developed either in the placenta or in the uterus (germinomatous). ...
... La localizzazione metastatica mandibolare (41,42) più frequente è quella per contiguità; questo sia perché i tumori locali hanno alta incidenza sia perché le metastasi da tumori primari localizzati a distanza sono poco frequenti (30) . La localizzazione metastatica a distanza alla mandibola è un infausto evento fortunatamente abbastanza raro, mentre al mascellare superiore è eccezionale ed il rapporto epidemiologico è 3:1 (30,39,43) . La frequenza epidemiologica vede una prevalenza nel sesso maschile ed in individui adulti talvolta nella fascia di età tra i 50 ed i 70 anni (13) . ...
... Metastasi che coinvolgono i processi condiloideo (44) o la branca montante, provocando un aumento di volume dell'osso, causano difetti di occlusione che comportano alterata masticazione. Uno dei sintomi di difficile interpretazione può essere il dolore (18) : gravativo o nevralgico, con irradiazione al territorio trigeminale e con compressione del nervo sensitivo tributario del territorio interessato, che provoca parestesia o anestesia cutaneo-mucosa (43) . Il sintomo d'esordio talvolta può essere una frattura patologica (4, 18,19,33,40,41,42) . ...
... Nel caso in cui ci si trovi in una situazione di primario occulto, se la diagnosi si orienta verso una patologia di natura dubbia e con imaging di primo livello non definibili (38) , si dovranno richiedere esami dedicati quali la Tomografia computerizzata ed il Dentascan. Il ricorso ad esami mediante scintigrafia con Tc (99) (scintigrafia ossea) si intraprendono per valutare l'estensione della lesione (19,20,23,33,13,30,43) e sono in genere con valenza total body per la localizzazione anche di altre sedi neoplastiche dove evidenzia le zone di rimaneggiamento; la FDG-PET (12) è un'indagine molto sofisticata che si propone per ricercare micro-metastasi total body sebbene i risultati siano dubbi nel senso che evidenzia anche siti di infiammazione. L'esame diagnostico principale nella diagnosi di una patologia con sospetto diagnostico tumorale e metastatico è il prelievo bioptico. ...
RIASSUNTO I tumori maligni secondari delle ossa mascellari sono lesioni molto rare, mentre rarissime sono le localizzazioni metastatiche ai tessuti molli del cavo orale. Essi sono molto comuni nelle fasi terminali del cancro. Esistono divergenze statistiche riguardo la loro incidenza che varia da 1% a 8% circa tra tutti i tumori dei mascellari. In evidenza tra le indagini di identificazione delle metastasi mandibolari sono la diagnostica radiologica e l'esame istopatologico con correlazione tra la lesione metastatica e quella primaria. La metastasi può essere riscontrata insieme al tumo-re o singolarmente. La diffusione metastatica può avvenire per via Cava, con primo filtro localiz-zato al polmone e poi al midollo osseo e per via Porta, con primo filtro al fegato e quindi al pol-mone e poi al midollo osseo; metastasi a partenza polmonare che raggiungono direttamente il midollo osseo; esistono comunque casi in cui gli " organi filtro " vengono, per così dire, " saltati " con comparsa di metastasi in organi posti successivamente. I tumori maligni primitivi che più di frequente portano metastasi mandibolare interessano nell'ordine: il polmone, la ghiandola mam-maria, il rene; altre neoplasie che più di rado metastatizzano alla mandibola sono: dall'intestino colon-retto, dalla tiroide, dalla prostata. Le sedi mandibolari più colpite sono in ordine decre-scente: la branca montante, il corpo, l'angolo, il condilo; probabilmente questi dati sono in rela-zione alla quantità e alla volumetria degli spazi midollari. Le metastasi mandibolari sono in gene-re osteolitiche; quelle osteoformative sono da riferire ad emboli neoplastici provenienti da neo-plasie prostatiche o renali. SUMMARY Secondary malignant tumours of the maxillary bones are very rare lesions, while metastatic soft tissue tumours of the mouth are even rarer. They are very common in the late stages of can
... Representan el 1 % de todas las neoplasias malignas de la cavidad bucal. [2][3][4][5][6][7][8][9][10][11][12][13] La metástasis del carcinoma en la cavidad bucal podrá localizarse en la mandíbula (80-90 %). [2][3][4][5][6][7][8][9][10][11][12][13][14][15] La región molar y retromolar son las zonas en las cuales con mayor frecuencia se localizan las metástasis 1,3-6,14,16 aunque pueden ser más raras en la encía, los tejidos blandos de la boca, el paladar blando y la lengua. ...
... [2][3][4][5][6][7][8][9][10][11][12][13] La metástasis del carcinoma en la cavidad bucal podrá localizarse en la mandíbula (80-90 %). [2][3][4][5][6][7][8][9][10][11][12][13][14][15] La región molar y retromolar son las zonas en las cuales con mayor frecuencia se localizan las metástasis 1,3-6,14,16 aunque pueden ser más raras en la encía, los tejidos blandos de la boca, el paladar blando y la lengua. ...
... 5 Aunque los tumores metastásicos en la cavidad bucal son raros, esa enfermedad tiene un gran significado clínico. Esto se debe a que en algunos casos su aparición puede ser el primer indicio de malignidad que apareció en una región atípica del tumor primario o la primera evidencia de la diseminación del tumor conocido desde su principal región, 6,9,12,14 como sucedió en el caso clínico presentado, donde la lesión en la cavidad bucal representó una diseminación de la enfermedad que después de 4 meses apareció en el cuero cabelludo. ...
The metastatic hepatic carcinoma is a complicated disease resulting in a high morbidity and mortality. Metastases in different sub-sites of oral cavity are a uncommon consequence of a distant spreading of disease. These metastases account for 1% of all malignant neoplasms of oral cavity and a few cases are described in literature. Authors try to inform health professionals on the epidemiological, histological and clinical trends of this pathological entity. Present paper reports a case of hepatocellular metastasis in a female patient aged 79 who came to Stomatology consultation of the State University of Maringá, Brazil presenting with an injury in the bottom of the right inferior groove in the canine region. The presence of metastasis in the mandibular region is infrequent and suggests a reserved prognosis. In the panoramic and periapical radiographs radiolucency was observed a region with poorly defined margins in the form of moth-eaten. The result of biopsy demonstrated that it was a metastasis caused by a probable primary tumor in liver. Metastasis was treated by the oncologist with poor results. The health professionals need information on this entity to treat their patients in a appropriate way, mainly at the light of the new epidemiological, histological and clinical knowledge.
... Representan el 1 % de todas las neoplasias malignas de la cavidad bucal. [2][3][4][5][6][7][8][9][10][11][12][13] La metástasis del carcinoma en la cavidad bucal podrá localizarse en la mandíbula (80-90 %). [2][3][4][5][6][7][8][9][10][11][12][13][14][15] La región molar y retromolar son las zonas en las cuales con mayor frecuencia se localizan las metástasis 1,3-6,14,16 aunque pueden ser más raras en la encía, los tejidos blandos de la boca, el paladar blando y la lengua. ...
... [2][3][4][5][6][7][8][9][10][11][12][13] La metástasis del carcinoma en la cavidad bucal podrá localizarse en la mandíbula (80-90 %). [2][3][4][5][6][7][8][9][10][11][12][13][14][15] La región molar y retromolar son las zonas en las cuales con mayor frecuencia se localizan las metástasis 1,3-6,14,16 aunque pueden ser más raras en la encía, los tejidos blandos de la boca, el paladar blando y la lengua. ...
... 5 Aunque los tumores metastásicos en la cavidad bucal son raros, esa enfermedad tiene un gran significado clínico. Esto se debe a que en algunos casos su aparición puede ser el primer indicio de malignidad que apareció en una región atípica del tumor primario o la primera evidencia de la diseminación del tumor conocido desde su principal región, 6,9,12,14 como sucedió en el caso clínico presentado, donde la lesión en la cavidad bucal representó una diseminación de la enfermedad que después de 4 meses apareció en el cuero cabelludo. ...
El carcinoma hepático metastásico es una enfermedad compleja con una alta morbilidad y mortalidad. Las metástasis en los diferentes subsitios de la cavidad bucal son consecuencia rara de una diseminación a distancia de la enfermedad. Estas representan el 1 % de todas las neoplasias malignas de la cavidad bucal y pocos casos se describen en la literatura. Se pretendió informar a los profesionales de la salud sobre las tendencias epidemiológicas, histológicas y clínicas de esta entidad patológica. El presente artículo reporta un caso de metástasis hepatocelular en una paciente de sexo femenino de 79 años de edad que asistió a la clínica odontológica de la Universidad Estatal de Maringá, Brasil, con lesión en fondo del surco inferior derecho en la región del canino. La presencia de una metástasis en la región mandibular no es frecuente e indica un pronóstico reservado. En los estudios radiológicos panorámico y periapical se apreció una región radiolúcida con márgenes mal definidos en forma de carcomido de polilla. El resultado de la biopsia informó que se trataba de una metástasis de un probable tumor primario en el hígado. La metástasis fue tratada por el oncólogo y se obtuvieron pobres resultados. Los profesionales de la salud necesitan información sobre esta entidad para tratar a sus pacientes correctamente, sobre todo a la luz de los nuevos conocimientos epidemiológicos, histológicos y clínicos.
... Alterations in sensitivity involving the lower lip, even without significant
radiological changes, should alert the expert to think about the possibility of an
initial metastasis1,21. For an accurate diagnosis and treatment of this rare
condition, detailed and careful evaluation of the clinical picture, associated with a
high degree of suspicion, is needed, requiring a multidisciplinary approach to the
case8,21. ...
... The unilateral paresthesia type, as occurred in this case, hypoesthesia or anesthesia of
the lower lip, known as Numb Chin Syndrome with or without the presence of pain, may be
the initial clinical manifestation of a significant percentage that manifests on the
jaw. Alterations in sensitivity involving the lower lip, even without significant
radiological changes, should alert the expert to think about the possibility of an
initial metastasis1,21. For an accurate diagnosis and treatment of this rare
condition, detailed and careful evaluation of the clinical picture, associated with a
high degree of suspicion, is needed, requiring a multidisciplinary approach to the
case8,21. ...
... In 25-35% of cases, the presence of
metastasis on the head and neck is the first sign of disseminated malignant disease, and
in about 70% of cases, metastatic lesions are diagnosed in conjunction with the primary
focus. Sometimes, however, the diagnosis of the primary lesion may be difficult or even
impossible2,21. ...
Prostate cancer represents the most frequent non-cutaneous neoplasia in males. This
type of neoplasia can develop peculiar patterns of evolution, presenting, in many
cases, precocious relapses and metastasis. Bone metastasis in the mouth is extremely
rare, and represents 1% of all malignant mouth neoplasias. The aim of the present
study is to report a clinical case of bone metastasis in the mandibular region
associated with a tumoral prostate adenocarcinoma, as well as to discuss connected
aspects about diagnosis, prognosis and integrated treatment of this condition.
... Regarding the gnathic bones, there is a prevalence of cases in mandible and only one case was reported in the maxilla. All age groups are affected [5]. ...
... Metastasis of thyroid carcinoma in mandible affect mainly the sixth and seventh decade of life according to the case reports in the literature [5,[15][16][17]. ...
Introduction: Thyroid carcinoma is a malignant neoplasia associated with radiation exposure, which is a risk factor for the disease, which induces cell mutation of that gland. Objective: On the basis of the above, the objective of this work is to present a clinical case of a patient whosought the Stomatology Service of the Federal University of Paraíba, complaining of swelling in the mandibular region. Case Report: Patient JMC, a 54-year old woman, melanoderma, sought the Stomatology Service of UFPB, bearing apanoramic radiography and reportings welling in the region of the body, on the left branch of the mandible, and the presence of local painful symptoms. The patient reported thyroid nodule removal two years ago. The clinical examination showed that the lesion presented exophytic growth and firm consistency, numerous diagnostic measures were performed, however, the only that provided the best results and accuracy of diagnosis was the biopsy. But as the diagnosis was very late, she came to death even before the completion of the usual surgical management. Conclusion: The diagnosis of primary and metastatic malignant gnathic bone neoplasms is primarily made on anamnesis, clinical, laboratorial, radiological, and histopathological data; thus being a multidisciplinary work.
... This is probably due to the paucity of red marrow in the mature jaw. 1 The most common tumors of origin are breast, lung, adrenal, kidney, gastrointestinal tract, and prostate, respectively. 2,3 On the other hand, distant metastasis of thyroid carcinoma is also rare (about 1 % -2 % of the well-differentiated types) and occurs most frequently in the lung and bone (vertebrae, pelvis, and the ribs). ...
... Mandible is the most common location and the molar area is the most frequent site of involvement. 1,4,7 This may be due to greater hematopoietic tissue in the mandible than the other jaw bones. However, the overall incidence of the jaw bones metastasis is less than other bones in the body which is probably because of gradual replacement of red marrow with yellow or fatty marrow. ...
Metastatic tumor of the mandible is a rare lesion and differentiated carcinomas of the thyroid as the primary site of origin are even more uncommon. A case of late metastasis of follicular thyroid carcinoma (FTC) to the mandible is presented here. The metastasis arose 12 years after thyroidectomy. Although relatively rare, thyroid tumors metastasis to the mandible should be born in mind, as in rare cases this metastasis may be the only presentation of the original malignancy.
... Our literature review of metastatic thyroid carcinomas (PTC and FV-PTC variant) to the oral cavity (with sufficient information) resulted in 26 cases from 16 articles including our case. The demographic features are summarized and presented in Table 1 [2,5,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The mean age was 54.4 (ranging from 13 to 69 years). ...
Metastasis to the jaws is a rare event; however, it has great importance because it may be the only symptom of an undiagnosed underlying malignancy. Papillary thyroid carcinoma, the commonest histopathologic variant of thyroid cancer, has minimal potential for distant metastasis, and most reported metastatic thyroid carcinomas of the oral cavity have been follicular thyroid carcinoma. The aim of this article is to present a rare case of metastatic papillary thyroid carcinoma, which presented itself as a painless expansion in the anterior region of the mandible in a 56-year-old female, and to review previously published cases of this type of cancer. Reporting rare cases such as this one, together with reviewing previous reports of related rare diseases, will expand the body of knowledge about these uncommon lesions.
... [1] Metastatic tumors to the oral and maxillofacial region have been reported to be extremely rare (1%-3% of all malignancies). [1][2][3][4] Out of these, about 65% have been reported to originate from the breast, lung, liver, kidney, and pancreas, while 35% originate from the testicles, uterus, thyroid, colon, rectum, stomach, and prostate. [5] The mandibular body-ramus region has been described as the most common location of metastatic lesions in the Ethical approval for the study was obtained from the Ethical and Research Committee, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. ...
ABSTRACT
Introduction
Metastatic tumours are lesions that originates from distant site and manifest in their secondary site remote from the primary. They are said to be rare in the maxillofacial region.
Materials and methods
This was a retrospective study from the Department of Dental and Maxillofacial Surgery and Department of Histopathology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, northwest, Nigeria from 2010-2016.
Results
A total of 259 cases of malignant tumours were seen out of which 8 cases (3.1%) were cases of metastasis. There were 4 males and 4 females (ratio 1:1). The age ranged from 20-75 years with mean±SD (55.6±18.8 years). Mandible was the chosen location for all the metastatic tumours in this series with the right body-ramus region frequently involved (4:50%), closely followed by the left body-ramus (3:37.5%) and 1 (12.5%) case seen in the parasymphyseal-symphyseal region. The prostate was the most frequent primary organ that metastasized to the maxillofacial region (3:37.5%).
Conclusion
High level of suspicion is required for early identification of these lesions and prompt referral is paramount as these tumours can be the first evidence of hidden malignancy at distant sites such as prostate, colon, lungs, breast and kidneys.
Keywords
Metastasis, oral and maxillofacial, primary cancers, prostate, thyroid
... F= female, M=male, N/A= not available, NED= no evidence of disease; ** FTC= follicular thyroid carcinoma, PTC= papillary thyroid carcinoma, MTC= medullary thyroid carcinoma, FVPC= follicular variant of papillary thyroid carcinoma, TCVPC= tall cell variant of papillary thyroid carcinoma; ***DOD= died of disease.Meyer and Shklar, 1965Soumar et al 1970Mc Daniel et al 1971Al-Ani, 1973Ripp et al 1977Stypulkowska et al 1979Draper et al 1979Nishimura et al 1982Osguthorpe and Bratton, 1982Tovi et al 1984Parichatikanond et al 1984Markitziu et al 1986Kahn and McCord, 1989Whitaker et al 1993Hefer et al 1998Vural and Hanna, 1998Agarwal et al 1998Anil et al 1999Erdag et al 1999Piattelli et al 2000Thomas et al 2001Bhansali et al 2003Colella et al 2003Ostrosky et al 2003Bodner et al 2006D'Silva et al 2006Liu et al 2007Tamiolakis et al 2007Kaveri et al 2007Antunes and Antunes, 2008Araki et al 2008Algahtani et al 2009Ismail et al 2009Seoane et al 2009Nishikawa et al 2010Kumar et al 2010Yokoe et al 2010Chaturvedy et al 2010Daley and Darling, 2011Kim et al 2011Muttagi et al 2011Shabestari et al 2012Nikitakis et al 2012Bhadage et al 2012Present case ριοχή και τις πλευρές, για τις οποίες απαιτήθηκε εκτομή υπερκλείδιου όγκου που περιέβαλλε το καρωτιδικό έλυτρο. Το ιατρικό ιστορικό περιλάμβανε επίσης καρκίνο του προστάτη, υπέρταση, υπερλιπιδαιμία, γαστροοισοφαγική παλινδρόμηση και ένα εγκεφαλικό επεισόδιο. ...
We present the unusual case of a 76-year old man with a history of tall cell variant of papillary thyroid carcinoma, presenting with a painless and easily bleeding swelling posterior to the second mandibular molar tooth, initially considered as a periodontal or tooth infection. Radiographic examination revealed a unilocular radiolucency in the left posterior mandible and I131 bone scan showed hot spots suggestive of a thyroid metastatic carcinoma to the posterior left mandible, the ribs and the left clavicle. Microscopic examination showed metastatic tall cell variant of papillary thyroid carcinoma. The patient was given radiation treatment, but 11 months later, approximately 8 years after the initial diagnosis of thyroid carcinoma, he died of his disease. A Medline search of the English literature from 1965 to December 2012 yielded 59 cases of metastatic thyroid carcinoma to the oral cavity and jaws, where the oral site of metastasis was specified and there was histologic confirmation.
... In general, oral metastases to the maxilla are rare, corresponding to less than one-fifth of all metastatic tumors to the jaws [8]. It has been suggested that the predilection of metastasis to the ramus and angle of the mandible reflects the rich blood circulation in the medullary cavity of these regions [8] The symptoms of a metastatic tumor in the mandible include pain, swelling, loosening of teeth, paresthesia, cervical lymphadenopathies and rarely pathologic fracture [9,10] In some cases these symptoms or signs may be the only manifestation of an undiscovered disseminated malignancy [11]. ...
Introduction:
Papillary carcinoma is the most frequent differentiated malignant thyroid neoplasm, Metastasis occurs frequently in regional lymph nodes and mandibular metastasis are very rare and most are secondary to follicular carcinomas due to their blood diffusion, The mandibular metastasis of papillary carcinoma is exceptional.
Case report:
We report a rare case of mandibular metastasis revealing papillary thyroid carcinoma in a 52-year-old patient, with a review of the literature on clinical features, radiological aspect, and treatment options.
Discussion conclusion:
Mandibular metastasis of thyroid cancer are rare and the initial metastases revealing papillary carcinoma are exceptional, few cases are reported in the literature, and due to their rarities and relative lack of data on their management, There is no clearly defined processing algorithm.
... There are few case reports of metastases from relatively uncommon sites such as esophagus and liver; however, we did not come across any metastasis from these sites in this study. [15,16] According to most of the studies, the most common histological type of mandibular bone metastases from a variety of primary tumors was adenocarcinoma which is in agreement with the data from our series. ...
Introduction: The metastatic disease of the jaw bones is very uncommon and accounts for approximately 1% of all malignancies of jaw. The most common location is molar region of mandible. Metastasis may go undetected on a routine skeletal survey for assessment of metastasis and rarely includes jaw bones. Aims and Objective: The aim of the study is to analyze primary malignancies in metastatic jaw tumors. Materials and Methods: We retrospectively studied clinicopathological features of 12 patients of metastasis to jaw bones diagnosed at tertiary cancer center between 2003 and 2011. All H and E and immunohistochemical slides were reviewed by two pathologists and relevant details were noted. Results: There were eight female and four male patients, with age range 12–71 years with metastases to jaws. All of them involved mandible with one case also showing the involvement of frontal sinuses. The types of metastatic tumors include adenocarcinoma (six cases), papillary thyroid carcinoma (four cases), carcinoma with neuroendocrine differentiation (one case) and neuroblastoma (one case). The diagnosis was made on biopsies in eight cases and on hemimandibulectomy in four cases. The primary site was known at the time of presentation only in four cases, all of them being thyroid carcinomas. Primary site was determined in seven cases after immunohistochemical workup on metastatic tumor and further investigations, whereas the primary site of carcinoma with neuroendocrine differentiation was unknown. Conclusion: Metastasis to jaw bones is rare and may be the first manifestation of unknown primary. A lesion predominantly involving bone with unusual morphology should raise a possibility of metastasis.
... There are few case reports of metastases from relatively uncommon sites such as esophagus and liver; however, we did not come across any metastasis from these sites in this study. [15,16] According to most of the studies, the most common histological type of mandibular bone metastases from a variety of primary tumors was adenocarcinoma which is in agreement with the data from our series. ...
Introduction: The metastatic disease of the jaw bones is very uncommon and accounts for approximately 1% of all malignancies of jaw. The most common location is molar region of mandible. Metastasis may go undetected on a routine skeletal survey for assessment of metastasis and rarely includes jaw bones.
Aims and Objective: The aim of the study is to analyze primary malignancies in metastatic jaw tumors.
Materials and Methods: We retrospectively studied clinicopathological features of 12 patients of metastasis to jaw bones diagnosed at tertiary cancer center between 2003 and 2011. All H and E and immunohistochemical slides were reviewed by two pathologists and relevant details were noted.
Results: There were eight female and four male patients, with age range 12–71 years with metastases to jaws. All of them involved mandible with one case also showing the involvement of frontal sinuses. The types of metastatic tumors include adenocarcinoma (six cases), papillary thyroid carcinoma (four cases), carcinoma with neuroendocrine differentiation (one case) and neuroblastoma (one case). The diagnosis was made on biopsies in eight cases and on hemimandibulectomy in four cases. The primary site was known at the time of presentation only in four cases, all of them being thyroid carcinomas. Primary site was determined in seven cases after immunohistochemical workup on metastatic tumor and further investigations, whereas the primary site of carcinoma with neuroendocrine differentiation was unknown.
Conclusion: Metastasis to jaw bones is rare and may be the first manifestation of unknown primary. A lesion predominantly involving bone with unusual morphology should raise a possibility of metastasis.
... In these cases, palliative options include pain management, radiotherapy, chemotherapy or local surgical excision. Palliative radiotherapy was commonly used in reported series and case reports (7)(8)(9)(10)(11)(12) and was also used in the case we presented. The ultimate goal of palliative treatment is to control the patient's pain and to preserve oral function. ...
Bone metastases are a common occurrence in patients with advanced cancer. The most common sites where bone metastases are found include the spine, pelvis, ribs and skull. Bone metastases from colorectal cancer are less common and cases where colorectal cancer has metastasized to the jaw bones are even more infrequently found in literature. Mandibular metastases are often found as a late complication of advanced cancer when there are already extensive metastatic lesions. Management offered to the patients are usually palliative in nature aiming to reduce the pain and preserve oral function to improve the quality of life of the patients. Treatment options include local surgical excision, chemotherapy or radiotherapy. We present the case of a 59-year-old female patient with primary rectal cancer with extensive metastatic lesions in multiple sites including the mandible.
... [1][2][3] However, mandible is the most common site for metastatic tumor among the ganthic bones accounting 80-90% of the cases. [4,5] Common primary sites are breast, lung, adrenal, kidney, gastrointestinal tract, and prostate. [1] Most common primary malignancies metastasizing to mandible are lung in male and breast in female. ...
Follicular carcinomas of thyroid have more prone to metastasize through hematogenous route and commonly involve bone, whereas papillary carcinomas spread through lymphatics. However, mandibular metastasis from thyroid malignancy is rare. Few cases have been reported until now. We are presenting a case of metastatic carcinoma of mandible and gingiva from follicular variant of papillary carcinoma of thyroid and interestingly secondary malignancy identified before the diagnosis of primary tumor.
... There have been more cases of metastasis to the jawbones than to oral soft tissues, recorded in literature. 3,4 These metastatic tumors more often than not turn out to be carcinomas than sarcomas. 5 The most common primary sources of metastatic tumors to the oral region are the breast, lung, kidney, bone, prostate and colon. ...
The pivotal reason for morbidity and mortality of any type of cancer is due to metastasis that occurs as a result of adaptation of genetically unstable cancer cells, in an ectopic conducive environment. Oral metastasis in spite of being unusual or rare represents around 25% of the first signs of metastatic spread. Literature says there are more number of cases of jaw bone metastasis reported than in the oral soft tissues. The most common primary organs metastasizing to the jaw bones and the oral soft tissues are the breast and the lungs respectively. The issue in diagnosing a metastatic tumor arises either when the patient does not reveal the history of the primary illness he or she may be suffering from or when he or she is unaware of it. Diagnosis in such situations is a challenge to the clinician or pathologist. Diagnosing any lymph node or distant metastasis from oral cancer is very important for the prognosis of the patient. In this review we have made an attempt, to explain some recent concepts of pathophysiology of the metastatic process, the clinical manifestations of metastatic tumors to the oral region and to discuss their diagnostic workup.
How to cite this article
Rao RS, Patil S, Sanketh DS, Amrutha N. Metastatic Tumors of the Oral Cavity. J Contemp Dent Pract 2014;15(2):263-271.
... Tooth extraction can serve as a promoting factor in the metastatic process. [15,16,20,26,27] Metastatic lesions may mimic odontogenic infections and other disease conditions leading to late diagnosis by the unwary clinician. However, in 24% of patients, the metastatic lesion in the oro‑facial region may be the first indication of an undiscovered malignancy at a distant site. ...
Cancer is a disease involving complex multiple sequential irreversible dysregulated processes showing metastasis that results in morbidity and mortality. Metastasis is a complex biological course that begins with detachment of tumor cells from the primary tumor, spreading into the distant tissues and/or organs, invading through the lymphovascular structures followed by their survival in the circulation. Metastatic tumors to the oro-facial region are uncommon and may occur in the oral soft tissues or jawbones. The clinical presentation of metastatic tumors can be variable, which may lead to erroneous diagnosis or may create diagnostic dilemma. Therefore, they should be considered in the differential diagnosis of inflammatory and reactive lesions that are common to the oral region. Most of the literature on oral metastases involves either single case reports or reviews of these reported cases from scattered geographical areas. Hence this present article is an attempt to provide a detailed review of pathogenesis, epidemiological details including clinical and radiographic presentations, microscopic features and treatment of metastatic tumors to the jaws and oral cavity.
... Studies have shown that most of the metastatic jaw tumors occur in 5th, 6th or 7th decades; in our series, they were found to occur at an earlier age, between 3rd and 7th decades. [5,7,13,14] In the younger age group (first to second decade of life), the metastasis was found to occur from adrenal neuroblastoma, medulloblastoma and osteogenic sarcoma. This shows that age and sex can give a clue to the possible primary site of a tumor that can metastasize to the jaw bones. ...
Being a tertiary referral center, we encounter the highest number of oral cancer patients in India, and there is direct involvement of the jaw bone in approximately 40% of these cases. There are no large case series from the Indian subcontinent on metastatic tumors to the jaw bones. With this retrospective analysis, we intend to estimate the incidence of this rare manifestation in the jaw bones in our patients and compare it with the available literature.
All patients with biopsy proven metastatic disease involving jaw bones having complete clinical data were included.
Nineteen out of 10,411 oral cancer patients who reported between the years 2000 and 2005 were included. Breast and thyroid malignancies (5/19 each) were commonest in the females to metastasize to the mandible, whereas in the males, there was no predominant site that resulted in jaw bone metastasis, although mandible was commonly affected. Neuroblastoma of adrenal gland metastasized to maxilla in the age group ranging from 4 months to 16 years. maxilla was the commonest jaw bone affected in this age group. in five cases, jaw bone was found to be the first site of metastasis.
There is variation in the primary site that causes metastasis to the jaw bones depending on age, sex and geographic distribution. Jaw bone metastases are rare and can be the first site of metastasis. We get approximately four cases in a year with metastatic disease manifesting in the jaw bones. Metastasis to jaw bone is associated with poor prognosis.
... Other atypical SCC oesophageal metastases include the iris while metastasis to the buttock from carcinomas involving the urinary bladder, kidneys and larynx have been documen- ted [5]. Oesophageal adenocarcinomas have also been reported to metastasise to rare bony areas such as the mandible [6]. The prognosis of oesophageal cancer is poor with the majority of patients with an unresected primary surviving less than 6 months. ...
Oesophageal carcinomas represent 3% of all cancers in the UK accounting for 7650 new cases per annum. Oesophageal cancer may be associated with swallowing abnormalities, localised mass pressure effects, lymphatic or distant metastatic spread.
We report a 50-year-old man who presented with a painful, enlarging, solid, fixed lesion adjacent to the left buttock with associated dysphagia. Initial endoscopic assessment suggested severe oesophageal inflammation while the lesion in the buttock area was presumed to be a primary soft-tissue neoplasm. However, subsequent histological assessment confirmed a primary oesophageal squamous carcinoma with metastatic spread to the buttock.
We discuss the clinical presentation, investigative modalities, and current therapeutic guidelines associated with this rare metastasis and present other atypical oesophageal musculoskeletal metastases. We emphasise the need to consider all aspects of patient symptomatology during the investigation of any atypical lesion.
... In addition to this triplicate publication, we also determined that the article " Jaw bone metastases: four cases " published in our journal by Tamiolakis et al. in 2007 (4) very closely resembles an article published by the same research group in Chirurgia (Bucur) in 2007 (9). Therefore the corresponding author has also retracted this paper (10). ...
Introduction and importance:
Metastatic esophageal carcinoma to the oral cavity has been rarely reported, and most cases were adenocarcinoma metastasizing to the mandible. This first report of a case of metastatic esophageal squamous cell carcinoma to the floor of the mouth is crucial due to its rarity and difficulties in diagnosing and managing this condition.
Case presentation:
A 53-year-old male had a painful submucosal mass on the left side of the floor of the mouth for 2 months. A biopsy indicated a moderately differentiated squamous cell carcinoma. Six months before the intraoral mass appeared, the patient had a moderately differentiated squamous cell carcinoma of the thoracic esophagus and was treated with concurrent chemoradiotherapy. With the previous history and pathological review, the diagnosis of metastatic esophageal squamous cell carcinoma to the floor of the mouth was made. Panendoscopy and an 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan revealed no other abnormality or other distant metastasis. The patient underwent surgical resection with postoperative chemoradiotherapy. He was able to take a regular diet and had good speech function. Ten months after treatment completion, he has had recurrent disease at the floor of the mouth with lung metastasis.
Conclusions:
Oral metastasis from esophageal squamous cell carcinoma is very rare and should be differentiated from primary oral cancer using clinical and pathological features. 18F-fluorodeoxyglucose positron emission tomography-computed tomography scanning is the preferred imaging method to exclude primary tumor persistence and other metastases. Treatment is usually palliative; however, function-preserving surgery may be an option for a patient with limited disease in the oral cavity.
Metastasis to the oral region are uncommon and account for about 1% of the oral malignant tumors and it may occur in the oral soft tissue or jaw bones. In 25% of cases, oral metastasis were found to be the first sign of the metastatic spread and in 23% it was the first indication of an undiscovered malignancy at a distant site. So we can say that oral cavity is the mirror of whole body. Oral lesions and manifestations suspect the possibility of metastasis from distant sites and that initiate the necessary investigations. This article has emphasised on various pathogenetic mechanisms related to tumours metastasizing to oral cavity.
The aim of this article was to present an asymptomatic lesion with insignificant clinical findings which turned out to be metastatic lesion in the jaws with primary in lung. The most common site of lung metastasis in the orofacial region is the mandible, but in our case it was seen in the maxilla. Metastases to the jaw bones occur in later stages. Hence, a careful examination of patients with jaw bone lesions is strongly suggested. Metastasis to the jaw should be considered while doing oral examination as observed in the current case because such lesions usually develop at terminal stage of cancer.
Distant metastasis to the jaws, including the maxilla or mandible, is very rare. Although the mandible is the preferred sight of these rare metastases, it is extremely rare for oral cavity malignancies to present as pathological mandibular fractures. Here, we present a case of esophageal adenocarcinoma metastasizing to the mandible, and the first reported case presenting with a pathological mandibular fracture secondary to esophageal adenocarcinoma. We also review the 9 other reported cases of metastatic esophageal adenocarcinoma to either the maxilla or mandible.
La glande thyroïde est le gendarme de la régulation corporelle. En France, une personne sur10 souffre de désordres thyroïdiens donc chaque jour l?odontologiste peut être confronté à cetype de patients.La régulation de la fonction thyroïdienne devra se faire tout au long de la vie et lesdérèglements pourront altérer certaines fonctions bucco-dentaires. C?est pourquoi nousavons étudié tous les désordres liés à un problème thyroïdien que nous avons synthétisés enplusieurs tableaux.Puis nous avons mis l?accent sur la prévention et le traitement de ces désordres en attachantune importance sur les éventuels efforts à faire par l?odontologiste suivant les résultatsretrouvés dans la littérature.
The purpose of the present article was to review the characteristics of the jawbone metastases to analyze all variables. A relevant English Literature search in PubMed, Scopus, and Google Scholar was performed. All variables such as age, gender, primary and secondary tumor sites were analyzed. There were 453 metastatic cases. The male-to-female ratio was 1.2:1, and the mean age of the patients was 53.4 years. The lung was the most common primary site in men, and breast in women. The most common metastatic site was the mandible, and adenocarcinoma was the most frequent histological diagnosis. Metastases to the jaw bones occur in the advanced stages of a malignancy hence; a careful examination of patients with jaw bone lesions is strongly suggested. Dentists, as well as general physicians, should take into consideration the possible presence of jaw metastases in cases which present atypical symptoms, especially in patients with known malignant disease.
Background:
Metastatic tumours to the oral cavity from distant organs are uncommon and represent approximately 1 - 3% of all oral malignancies. Such metastases can occur to the bone or to the oral soft tissues. Almost any malignancy from any site is capable of metastasis to the oral cavity and a wide variety of tumours have been reported to spread to the mouth.
Methods:
Careful examination of the oral cavity and a high degree of clinical suspicion as well as a multidisciplinary approach are suggested.
Results:
In this article we present three patients, a female and two males with metastatic tumours to the oral cavity, who were referred to our Department. The primary tumours were invasive lobular breast carcinoma, gastric adenocarcinoma and small cell lung carcinoma respectively.
Conclusions:
Metastases to the oral cavity are quite uncommon among population. They usually present with symptoms similar to odontogenic infections and benign tumours, causing a delayed diagnosis and treatment.
Metastatic tumors of the oral region constitute a rare entity with very few reported cases and exhibiting symptoms that may mimic common dental and periodontal infections and benign lesions and are often diagnosed at an advanced stage of disease leading to a poor and unfavorable prognosis. This article seeks to review existing literature regarding the metastatic lesions in order to increase awareness of the occurrence in order to help in early detection, diagnosis and better prognosis.
Introduction
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Local metastasis is common but metastasis to the jaw is rare with 40 reported cases in the English language literature.
Report of case
We describe a case of a 54-year old man who, for the past two months, had noticed a rapidly growing facial mass in the posterior mandibular area. The patient was known to be a hepatitis C virus carrier and suffered from liver cirrhosis but the presence of HCC was unknown.
Methods and results
The English language literature was searched for documented cases of HCC metastasis to the jaw, applicable data was evaluated. The literature analysis revealed 41 reported cases (including the present case). In most cases (81%) the jaw lesion was the only known metastasis at the time of HCC diagnosis. Clinical presentation occurred up to 2 years before discovery of the jaw metastasis. Patients with HCC jaw metastasis have a poor survival rate with an average of 6.1 months between diagnosis and death.
Conclusions
This study shows that an isolated jaw mass may be the initial presentation of HCC and therefore must be considered in the differential diagnosis, especially in the presence of known liver cirrhosis or chronic viral hepatitis.
Around 1 % of oral cancers are metastases from distant sites. Tumor metastases to the jaw bones are uncommon and are most likely to arise from primary lung, breast, prostate or kidney tumors. Jaw bone metastases from a primary esophageal adenocarcinoma are especially rare, with only 7 reports published in the literature. Here, we describe a case of a 69 year-old male patient where 7 years elapsed between the diagnosis and successful treatment of a poorly differentiated, stage pT2N0 primary esophageal adenocarcinoma and re-presentation with jaw pain due to a metastatic mandibular deposit. The morphological appearance of the metastasis and immunohistochemical positivity with CK20, CK7 and CDX2 strongly supported an adenocarcinoma of upper gastrointestinal tract origin. This case is of particular interest as there is an unusually long time between the detection of the primary esophageal adenocarcinoma and diagnosis of metastatic disease. The longest period of time we have found for this in the literature is 9 months, although it is also reported that some oral metastases may appear more than 10 years following the primary tumor diagnosis.
Metastatic tumors to the oral cavity are uncommon and a thyroid origin is considered exceedingly rare. A case of metastatic papillary thyroid carcinoma (PTC) presenting as a painful swelling in the right posterior maxilla of a 63-year-old male is reported here. The patient had been diagnosed with PTC 2 years ago and treated with thyroidectomy and radioactive iodine treatment. Radiographically, the metastatic lesion presented as a poorly-defined radiolucent lesion around an impacted maxillary third molar in the right maxilla. Histopathologic examination revealed features of PTC which was immunohistochemically positive for pancytokeratin, keratin 19 and thyroglobulin. Imaging studies revealed the presence of residual maxillary and neck disease as well as additional metastatic lesions in the sternum, ribs, and left tibia. A thorough review of the English language literature revealed only 36 previously published cases of thyroid cancer metastases to the oral cavity, the demographic and clinicopathologic features of which are summarized.
A 78-year-old woman heard a crack in her left mandible while eating a biscuit and reported to her dentist, who urgently referred her to the oral and maxillofacial surgery department. On examination she had a lesion in the body of her left mandible, which had eroded through the lower border and caused a pathological fracture. Her past medical history included a left mastectomy and level II axillary lymph node dissection for a 27 mm grade III invasive ductal carcinoma of the left breast 9 months prior to her mandibular fracture. A transoral incisional biopsy was performed which confirmed the mandibular lesion to be an osteolytic metastasis from the breast. The metastasis was subsequently surgically removed and the remaining mandible repaired with a reconstruction plate followed by postoperative radiotherapy. The patient regained full function of her mandible and is now eating normally. She is being closely followed-up in the oncology outpatient department.
PRIMARY malignant tumors in the nasal cavity, although rare, have been recognized for a long time. These tumors usually occur as polypoid masses arising from the mucosa of the nose or the nasal sinuses. In the latter case, symptoms of bleeding and pain may be noted or presence of the tumor may first be recognized by radiological manifestations of bone destruction. In many instances, carcinoma may be found on routine pathological examination of material removed during radical procedures on the antrum. By far the greater number of cases are squamous-cell carcinomas, although a small percentage are adenocarcinomas, of which the mucinous type is distinctive.
McComb and Martin1 published a report in 1942 analyzing 65 cases of cancer of the nasal cavity. Of these, 11 cases were adenocarcinomas (17%). In a thorough search of the literature, both textbooks and medical journals, I was unable to find any reference to metastasizing
Metastatic tumours to the jaw bones are uncommon. The incidence of jaw bone metastasis is difficult to assess accurately since the usual method to determine the distribution of a metastatic tumour has been by a radiographic skeletal survey in which the jaws are rarely included. At times, metastatic lesions of the orofacial region may be the first evidence of dissemination of a known tumour from its primary site. A case of metastatic follicular carcinoma of the thyroid to the mandible is presented. The present case emphasizes the importance of considering metastasis in the differential diagnosis of a radiolucent lesion in the mandible in a patient with a history of any malignant disease.
In thirty-two cases of histologically verified metastases to the jaws treated between 1944 and 1968, breast and lung carcinomas were the most common primary tumors, followed by thyroid carcinoma, carcinoma of the prostate, malignant melanoma, osteogenic sarcoma, retinoblastoma, hepatoma, renal-cell carcinoma, leiomyosarcoma, and an unknown adenocarcinoma. In nine cases, the jaw metastasis was the initial manifestation.
Lorsqu'une tumeur metastase a la cavite buccale il s'agit d'un stade avance et le pronostic est sombre. La majorite des malades decede dans l'annee suivant le diagnostic de la metastase, la survie a 4 ans est de 10%
One per cent of all malignant tumors produce metastatic foci in the jaws, with breast carcinoma being one of the most commonly metastasizing malignant tumors to the jaws in women. Such lesions should always be considered in the differential diagnosis of painful bone lesions, especially if there is a history of breast surgery for carcinoma.
A retrospective study was undertaken to analyse the etiology, site and treatment procedures of 30 pathological fractures of the mandible. Fifty percent of the fractures had an inflammatory cause. The remaining cases were associated with severe atrophy of edentulous mandibles (4), benign tumours (3), cysts (3), and primary or secondary malignancies (5). Regardless of the cause, the majority of the fractures occurred in the body of the mandible. Pathological fractures of the mandible most often have to be treated by eliminating the cause of the underlying condition while immobilizing the fragments either with osteosynthesis or archbars and intermaxillary fixation.
We wish to thank Terry Schoop of Biomed Arts Associates, San Francisco, for preparation of the figures, Cori Bargmann and Zena Werb for insightful comments on the manuscript, and Normita Santore for editorial assistance. In addition, we are indebted to Joe Harford and Richard Klausner, who allowed us to adapt and expand their depiction of the cell signaling network, and we appreciate suggestions on signaling pathways from Randy Watnick, Brian Elenbas, Bill Lundberg, Dave Morgan, and Henry Bourne. R. A. W. is a Ludwig Foundation and American Cancer Society Professor of Biology. His work has been supported by the Department of the Army and the National Institutes of Health. D. H. acknowledges the support and encouragement of the National Cancer Institute. Editorial policy has rendered the citations illustrative but not comprehensive.
Associate Director, Department of Pathology, Hippokration Hospital of Thessaloniki, Greece. Theodoros Jivanakis, MD, Director, Department of Pathology, Regional Hospital of Drama
- George Alexiadis
- Radiodiagnostic Center
George Alexiadis, MD, Radiodiagnostic Center, Alexandroupolis, Thrace,
Greece.
Ioannis Venizelos, MD, Associate Director, Department of Pathology,
Hippokration Hospital of Thessaloniki, Greece.
Theodoros Jivanakis, MD, Director, Department of Pathology, Regional
Hospital of Drama, Greece.
Nikolas Papadopoulos, MD, Associate Professor, Department of
Histology-Embryology, Faculty of Medicine, Democritus University of
Thrace, Dragana, 68100 Alexandroupolis, Greece, corresponding
author, E-mail: npapad@med.duth.gr
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