Solid malignant metastases in the jaw bones

Incidence rate of metastases in the oral cavity: a review of all metastatic lesions in the oral cavity

Background

Metastases in the oral cavity are rare and account for only 1 to 3% of all malignant lesions in this area. The primary location from which most metastases have been described in the oral cavity in adult patients include lungs, breasts, kidneys and colon.

Material and Methods

A systematic search of the literature was carried out following the PRISMA statement in PubMed database. Clinical trials and case series published in the last 10 years [2010-2020] were eligible to be selected. The headings and keywords used in the searches were “cancer” AND “oral metastases”, “incidence” AND “oral metastases”, “oral metastases” AND “jaw bone”, “oral metastases” AND “soft tissue”.

Results

For the study of the incidence of metastases in the oral cavity, 9 reports of clinical trials and 7 retrospective studies of case series have been included in this article. The primary locations from which more metastases have been described in the oral cavity are lungs (30.6% or 183 cases), breasts (22.2% or 133 cases), liver (15.5% or 93 cases), prostate (9 % or 54 cases), thyroid glands (8.1% or 49 cases), kidneys (7.3% or 44 cases), skin (2.3% or 14 cases), soft tissues (2% or 12 cases), colon (2% or 12 cases) and gastrointestinal (0.6% or 4 cases). These metastases have a predilection for hard tissues. The clinical presentation of these lesions varies from painless granulomatous lesions to lytic areas in the jaws.

Conclusions

Although metastases in the oral cavity is an uncommon pathology, early diagnosis is needed so that in the event that it is the first manifestation, it allows the primary tumor to be diagnosed as soon as possible.

Key words:Cancer, oral metastases, incidence, jaw bone, soft tissue.

Pancreatic adenocarcinoma metastasis to the oral cavity: A rare case report and literature review

A patient suffering from metastatic pancreatobiliary adenocarcinoma was referred to our hospital's stomatology department after a rapidly progressing swelling in the right mandibular angle, trismus and preauricular pain of 3-month duration. A mandible CT scan showed extensive bone rarefaction and a thickening of the contiguous soft tissues that involved the medial masseter and pterygoid muscle. The morphological findings and immunohistochemical profile were compatible with bone metastasis from pancreatic adenocarcinoma. Therefore, palliative treatment was proposed to the patient. Pancreatic cancer metastases to the oral cavity are extremely rare and characterized by its poor prognosis. Herein we describe the ninth case of metastatic spread to the jaw which is also remarkably the longest surviving reported case up to date.

Radiological spectrum of metastasis to the oral and maxillofacial region

OBJECTIVE

Oral and maxillofacial metastasis may be the first indication of an undiscovered malignancy in a significant number of cases. Therefore, the rationale of this article is to highlight the clinical and radiological presentation of metastatic lesions involving the oral and maxillofacial region. This will serve as a reference for clinicians, who may first encounter patients with possible metastatic lesions in this region.

METHODS

Histologically confirmed cases of oral and maxillofacial metastasis were retrospectively reviewed over a 30-year period. Twenty-three patients were included in the study. The following clinical information was reviewed: age at diagnosis, gender, medical history, main complaint, site of metastatic tumour, radiological features, preliminary clinical diagnosis and final histological diagnosis.

RESULTS

Females were twice as commonly affected, with metastatic lesions three times more likely to occur in the mandible. Common clinical presentations included swelling, pain and paraesthesia, with non-specific dental-related symptoms occurring in a few cases. Fifteen cases presented radiologically with an osteolytic lesion with poorly demarcated margins. Four cases presented with well demarcated lesions with additional signs of destruction. Additionally, four cases showed an osteogenic radiological appearance. In the current population sample, metastasis to the oral and maxillofacial region most commonly originated from the breast.

CONCLUSION

Lesions with poorly demarcated margins with cortical destruction, accompanied by clinical signs of swelling, pain and paraesthesia in the absence of any inflammatory process, should raise suspicion for metastasis. Considering the poor prognosis of these metastatic lesions, the responsibility lies with the clinician to identify these lesions and make appropriate referrals.

Mandibular tumour as the primary manifestation of an occult adenocarcinoma

Oral cavity is an uncommon site for occurrence of metastasis and usually indicates widespread systemic disease. Primary tumours from the lung most commonly metastasise to oral soft tissues (31.3%) and jaw bones (22%) among men. It is quite challenging to diagnose a solitary metastatic lesion and to determine the site of primary lesion, due to the rarity of these occurrences. This case report describes the jaw bone as a first sign of occult primary lung adenocarcinoma with multiple metastases in 47-year-old man. The patient was treated with the combination of carboplatin and paclitaxel, and has completed two cycles till date with a stable clinical course. Diagnosis of metastatic carcinoma of jaw is very challenging. The pathologist must have knowledge of ancillary techniques along with clinical, radiological and histological correlation to determine the origin of distant primary.

Metastasis of Colon Adenocarcinoma to Maxillary Gingiva and Palate

INTRODUCTION

Colon adenocarcinoma is one of the foremost causes of cancer mortality. Oral metastasis of colon adenocarcinoma is, however, rare and indicates an end-stage disease process.

CASE REPORT

We report a case of a 69-year-old female with a gingival mass diagnosed with colon adenocarcinoma and liver metastasis after one year. A swelling was found in the maxillary right buccal and lingual gingiva during physical examination. Tissue biopsy revealed an intestinal metastatic adenocarcinoma. The patient underwent chemotherapy for treatment. We also reviewed all reported cases of gingival metastasis due to colon adenocarcinoma.

CONCLUSION

Careful examination of the oral cavity in patients with the adenocarcinomas of various organs is beneficial in the early diagnosis of metastasis since the most frequent metastatic lesion of the oral cavity is adenocarcinoma.

Mandibular metastasis from lung adenocarcinoma as the first sign of occult malignancy

Metastatic disease to the oral and maxillofacial region is rare, with only about 1% of oral malignancy attributed to metastases. In approximately 20% of these patients, oral metastases are discovered before the detection of the primary tumor. Here we present a case of a 66-year-old man who presented with vague left mandibular pain and new-onset lip numbness as the first sign of occult malignancy from lung adenocarcinoma with multiple metastases.

Hidden intra-mandibular carcinoma cuniculatum appearing in a patient with metastatic prostate cancer: a case report

Background

Whereas the incidence of cancers increases, overall survival of cancerous patients improves. Preventing the onset of second primary cancer is a new public health challenge and requires a special attention from organ specialists. We report a rare case of carcinoma cuniculatum in a context of metastatic prostate cancer. No case was previously described. Diagnosis delay of carcinoma cuniculatum is frequent and particularly in case of endophytic intra-osseous topography. The aim of this case report is to remind that persistent pain requires medical evaluation to rule out any possibility of second primary cancer.

Case presentation

A 78-year-old patient followed for a metastatic prostate cancer had been describing neuralgic dental pain in the lower posterior left quadrant for several months. Healing delay of tooth #37 (second left mandibular molar) extraction socket in the painful region led to an intra-alveolar incisional biopsy, which showed a tumor widely invading the mandibular body. Radiologic, histopathologic and clinical elements finally concluded to an intra-osseous carcinoma cuniculatum. Duration of total treatment (oral biopsy to hemimandibulectomy) and follow up were about five months and one year respectively. Patient died before reconstruction.

Conclusion

This case recalls that any persistent tooth pain affecting cancer patients requires a thorough review to exclude any secondary primary cancers or any metastasis of the oral cavity and more specifically in jawbones.