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Goto Y, Hijioka H, Uchino Y, Sugiura T, Okui T. Numb Chin Syndrome as the Initial Presentation of Mandibular Metastasis of Colorectal Cancer: A Case Report. Cureus 2024; 16:e56133. [PMID: 38618368 PMCID: PMC11015111 DOI: 10.7759/cureus.56133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
Numb chin syndrome (NCS) is hypesthesia of the mandible and lower lip caused by damage to the inferior alveolar or mandibular nerves, commonly due to dental treatment or osteomyelitis, but occasionally caused by malignant tumors. We report the case of a male in his 60s. He came to our hospital with a chief complaint of mandibular pain and paresthesia in the right side of the mental region. He had noticed swelling of the left mandible one month before the initial visit and strong hypesthesia of the right side of the mental region one week before the initial visit. Panoramic radiographs showed slight osteosclerosis of the left side mandible at the initial visit. Blood tests showed only a slight inflammatory reaction. The diagnosis of mandibular osteomyelitis and numb chin syndrome was made, and a contrast-enhanced CT scan was performed to investigate the possibility of neoplastic lesions, but no obvious cause was found. Osteosclerosis was minimal. A tissue biopsy was recommended, but the patient did not consent. Considering the possibility of NCS due to a hematologic disorder, the patient was referred to a hematologist, but no cause could be identified at the initial visit. With time, the markedly severe pain worsened, and the possibility of a neoplastic lesion was again suspected. Blood tests were performed, which revealed abnormally high levels of CA19 and CEA. He consulted a gastroenterologist, who found a tumor in the ileocecal region on contrast-enhanced CT, and multiple systemic metastases were found on a PET-CT scan the next day. Systemic chemotherapy was administered for multiple metastatic unresectable colorectal cancer (cT4N1aMc2 stage IVc).
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Affiliation(s)
- Yuichi Goto
- Department of Maxillofacial Diagnostic and Surgical Science, Kagoshima University, Kagoshima, JPN
| | - Hiroshi Hijioka
- Department of Maxillofacial Diagnostic and Surgical Science, Kagoshima University, Kagoshima, JPN
| | - Yoshinori Uchino
- Department of Maxillofacial Diagnostic and Surgical Science, Kagoshima University, Kagoshima, JPN
| | - Tsuyoshi Sugiura
- Division of Oral and Maxillofacial Oncology and Surgical Science, Tohoku University, Sendai, JPN
| | - Tatsuo Okui
- Department of Maxillofacial Diagnostic and Surgical Science, Kagoshima University, Kagoshima, JPN
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Huang XF, Yu ZL. Clear Cell Renal Cell Carcinoma Metastatic to the Mandible: a Unique Case Report and Literature Review. Chin J Dent Res 2023; 26:265-270. [PMID: 38126372 DOI: 10.3290/j.cjdr.b4784061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Renal cell carcinoma (RCC) is often diagnosed in advanced stages and a third of patients have distant metastasis at diagnosis. Metastasis may be the first evidence of clear cell RCC in many cases. RCC most often metastasises to the lung, liver, bone, brain and thyroid; however, metastatic disease to the oral cavity, especially the mandible, is rare. The purpose of this study is to report a case of clear cell RCC metastatic to the mandible and review the literature. The mandible lesion underwent radical excision in this case. Notably, no metastatic lesions were detected in the lungs and liver in this patient until 15 months after the mandibulectomy. The patient lived for around 2.5 years after the diagnosis of RCC.
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Huang Y, Bao Y, Xu D, Liu L. Gingival metastasis from primary hepatocellular carcinoma: a case report. J Int Med Res 2022; 50:3000605221113408. [PMID: 35883281 PMCID: PMC9340352 DOI: 10.1177/03000605221113408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide;
however, cases with metastasis to the oral cavity are extremely rare. Herein, we report a
68-year-old man who was diagnosed with HCC. Ten months after surgical removal of the right
half of his liver, the patient developed gingival metastasis. Unfortunately, the patient
died 4 months after the diagnosis. We discuss treatment options, pathological results, and
disease prognosis. When a mandibular gingival mass is found, metastatic tumors should be
considered in the differential diagnosis. In this regard, the patient’s medical history
and physical examination are valuable indicators for the diagnosis of mandibular gingival
metastasis. This case provides a basis for the clinical diagnosis of metastatic HCC
involving the oral cavity.
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Affiliation(s)
- Yuan Huang
- Department of Gastroenterology, Yanbian University Hospital, Jilin, China
| | - Yanqiu Bao
- Department of Pathology, Yanbian University Hospital, Jilin, China
| | - Dongyuan Xu
- Department of Pathology, Yanbian University Hospital, Jilin, China
| | - Lan Liu
- Department of Pathology, Yanbian University Hospital, Jilin, China
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Rashid N, Bansal A, Chug A. Intestinal-type Adenocarcinoma Presenting as a Mandibular Mass: An Unusual Presentation. Contemp Clin Dent 2021; 12:99-101. [PMID: 33967548 PMCID: PMC8092088 DOI: 10.4103/ccd.ccd_217_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/28/2020] [Accepted: 07/22/2020] [Indexed: 11/09/2022] Open
Abstract
Intestinal-type adenocarcinoma is an aggressive malignancy with the rare possibility of metastatic spread to the mandible. We represent a case of a 30-year-old female patient who reported with a chief complaint of a right mandibular mass for 4 months. Orthopantomogram X-ray observed an ill-defined lytic lesion with severe periosteal reaction. Incisional biopsy revealed “colonic variant of intestinal-type adenocarcinoma.” Expression of cytokeratin 20 and caudal type homeobox transcription factor 2 (CDX-2) markers was seen on immunohistochemistry. Biochemical markers such as serum cancer antigen 125, serum alkaline phosphatase, and serum carcinoembryonic antigen were raised. Contrast-enhanced computed tomography of the thorax and abdomen suggested cavitary lesions in the bilateral lungs, right adrenal gland, and mediastinum. Positron emission tomography revealed multiple lesions in the body, hence confirming the diagnosis. The patient was kept on palliative chemotherapy. It is concluded that prompt diagnosis and initiation of treatment increases the chances of survival in such cases.
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Affiliation(s)
- Nouman Rashid
- Department of Dentistry (Cranio-Maxillofacial Surgery), AIIMS, Rishikesh, Uttarakhand, India
| | - Adity Bansal
- Department of Dentistry (Cranio-Maxillofacial Surgery), AIIMS, Rishikesh, Uttarakhand, India
| | - Ashi Chug
- Department of Dentistry (Cranio-Maxillofacial Surgery), AIIMS, Rishikesh, Uttarakhand, India
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Ludwig DC, Garcia J, Chang OH, Closmann JJ. Metastatic renal cell carcinoma to the mandible: a case report with clinical and histologic findings. Gen Dent 2020; 68:41-44. [PMID: 32348242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Metastatic disease to the oral cavity is rare. Patients with metastasis to the oral cavity may present with swelling, pain, and paresthesia and require evaluation by providers trained in managing pathoses of the oral cavity and surrounding structures. This report describes the case of a 78-year-old man with painful enlargement of the right posterior mandible that caused paresthesia. An open biopsy procedure resulted in significant blood loss and the need for percutaneous needle biopsy. Immunohistochemical analysis was used to make the diagnosis of metastatic clear cell renal cell carcinoma in this patient, whose primary malignancy was previously unknown. Composite resection of the metastatic lesion and reconstruction were performed with the use of virtual surgical planning, an osteomyocutaneous free tissue transfer, and a custom reconstruction plate. This case highlights the importance of dental professionals in the diagnosis and management of lesions of the head and neck and adds to the literature on metastatic lesions to the region.
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Johnson C, Read-Fuller A. Mandibular metastasis from lung adenocarcinoma as the first sign of occult malignancy. Proc (Bayl Univ Med Cent) 2020; 33:261-262. [PMID: 32313481 DOI: 10.1080/08998280.2020.1719783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Cameron Johnson
- Department of Oral and Maxillofacial Surgery, Baylor University Medical CenterDallasTexas.,Department of Oral and Maxillofacial Surgery, Texas A&M College of DentistryDallasTexas
| | - Andrew Read-Fuller
- Department of Oral and Maxillofacial Surgery, Baylor University Medical CenterDallasTexas.,Department of Oral and Maxillofacial Surgery, Texas A&M College of DentistryDallasTexas
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Gupta N, Khare A. Isolated Mandibular Metastasis Detected on Staging 18FDG PET/CT Scan in a Case of Carcinoma Urinary Bladder. Indian J Nucl Med 2020; 35:178-180. [PMID: 32351280 PMCID: PMC7182318 DOI: 10.4103/ijnm.ijnm_18_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 11/04/2022] Open
Abstract
Isolated mandibular metastasis is very rare from carcinoma urinary bladder with no locoregional lymph node involvement. Here, we present a case where staging fluorodeoxyglucose - positron emission tomography - computed tomography (FDG PET-CT) scan showed an FDG avid primary lesion in carcinoma urinary bladder with FDG avid erosion in the right mandibular condyle. However, since no pelvic lymph nodes were involved, the mandibular lesion was kept on follow-up and cystoprostatectomy was performed. Follow-up FDG PET-CT scan after 6 months revealed an osteolytic destructive lesion in the mandible with associated soft tissue component and the biopsy confirmed this as metastatic lesion.
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Affiliation(s)
- Nitin Gupta
- Department of Nuclear Medicine, Sir Ganga Ram Hospital, New Delhi, India,Address for correspondence: Dr. Nitin Gupta, Department of Nuclear Medicine, Sir Ganga Ram Hospital, New Delhi - 110 060, India. E-mail:
| | - Abhishek Khare
- Department of Nuclear Medicine and PET/CT, Platinum Imaging Centre, New Delhi, India
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Frydenlund N, Zakharia Y, Garje R, Dahmoush L, O'Donnell MA. Non-Muscle Invasive Papillary Urothelial Carcinoma Metastatic to the Mandible. J Investig Med High Impact Case Rep 2018; 6:2324709618806332. [PMID: 30349834 PMCID: PMC6194919 DOI: 10.1177/2324709618806332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 11/28/2022] Open
Abstract
Urothelial carcinoma, the most common histologic subtype of bladder cancer in the United States, most frequently presents as non–muscle invasive disease. Initially, therapy involves transurethral endoscopic resection and subsequent intravesical therapies with extended surveillance for high-risk disease. Even with the best treatments, recurrence and progression can occur. However, metastasis of non–muscle invasive bladder cancer to distant sites without evidence of progression or regional metastasis is rare. In this article, we present the case of a patient with high-grade papillary urothelial carcinoma who developed an unusual metastasis to the mandible, confirmed by GATA-3 immunostaining, over 4 years after initial transurethral resection. Prior to the development of metastatic disease, this patient had no evidence of local recurrence during maintenance Bacillus Calmette-Guerin intravesical therapy and concurrent surveillance. Positron emission tomography-computed tomography taken after presentation with mandibular metastasis did not show any evidence of regional metastasis. This case highlights an unusual location for distant metastasis of urothelial carcinoma occurring in a patient without evidence of muscle invasive disease or regional metastasis. We additionally highlight the utility of GATA-3 immunostaining in identifying urothelial carcinoma histologically.
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Affiliation(s)
| | - Yousef Zakharia
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Rohan Garje
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Laila Dahmoush
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Matsuda S, Yoshimura H, Yoshida H, Umeda Y, Imamura Y, Sano K. Mandibular metastasis as the first clinical indication of occult lung adenocarcinoma with multiple metastases: A case report. Medicine (Baltimore) 2018; 97:e0296. [PMID: 29642152 PMCID: PMC5908619 DOI: 10.1097/md.0000000000010296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Although metastases to the oral and maxillofacial region (OMR) are rare, the lung is the most common primary site metastasizing to the OMR. PATIENT CONCERNS An 83-year-old woman presented with reports of trismus, occlusal discomfort, swelling, and spontaneous pain in the right buccal region. Despite the absence of abnormal chest imaging findings, immunohistochemical analysis of biopsy specimens of the mandible and the thyroid indicated that the patient had multiple metastases from a lung poorly differentiated adenocarcinoma. DIAGNOSES Metastases to the OMR and the thyroid from an undiscovered lung adenocarcinoma. INTERVENTIONS Gefitinib was started as first-line chemotherapy, and zoledronic acid was administered for bone metastases. OUTCOMES Follow-up imaging examinations showed ossification and deformation of the right mandibular ramus and the condylar process. Although 2 years have passed since the first visit to our hospital, lung lesions have not been confirmed by imaging examinations. LESSONS Clinicians should consider the possibility that symptoms in the OMR may be the first clinical sign of an undiscovered distant primary tumor, and the primary tumors may not be detected by imaging examinations even when metastases to the OMR are revealed.
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Affiliation(s)
- Shinpei Matsuda
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine
| | - Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine
| | - Hisato Yoshida
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine
| | - Yukihiro Umeda
- Third Department of Internal Medicine, Unit of General Medicine, Division of Medicine, Faculty of Medical Sciences
| | - Yoshiaki Imamura
- Division of Surgical Pathology, University of Fukui Hospital, Fukui, Japan
| | - Kazuo Sano
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine
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Ambelil M, Sultana S, Roy S, Gonzalez MM. Anaplastic Transformation in Mandibular Metastases of Follicular Variant of Papillary Thyroid Carcinoma: A Case Report and Review of the Literature. Ann Clin Lab Sci 2016; 46:552-556. [PMID: 27650625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Anaplastic transformation of well-differentiated thyroid carcinomas at distant metastatic sites is a rare condition. Most cases described in the literature have occurred in the thyroid or regional lymph nodes. We report a case of anaplastic transformation of the follicular variant of papillary thyroid carcinoma in mandibular metastases. A 76-year-old female presented with a painful and enlarging mandibular mass. She had been treated in the past for the follicular variant of papillary thyroid carcinoma. A palliative hemi-mandibulectomy was performed. Histology revealed a metastatic papillary thyroid carcinoma, follicular variant, with an unusual finding of solid pleomorphic epithelioid and spindle cell areas, consistent with anaplastic transformation.
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Affiliation(s)
- Manju Ambelil
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX, USA
| | - Sadia Sultana
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX, USA
| | - Suvra Roy
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX, USA
| | - Maria M Gonzalez
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX, USA
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Tejani N, Cooper A, Rezo A, Pranavan G, Yip D. Numb chin syndrome: a case series of a clinical syndrome associated with malignancy. J Med Imaging Radiat Oncol 2014; 58:700-5. [PMID: 24966131 DOI: 10.1111/1754-9485.12177] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/04/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Information regarding the appropriate work-up and outcomes in patients receiving palliative treatment for numb chin syndrome (NCS) in the setting of malignancy is sparse. This study aims to describe NCS in malignancy and evaluate the disease trajectory, significance of diagnostic modalities and outcomes with palliative treatment. METHODS A retrospective study was performed on patients presenting with NCS between March 2007 and October 2013 at the Capital Region Cancer Service, Canberra. RESULTS Thirteen patients were identified who presented with numbness of the chin between March 2007 and October 2013. Seven patients had breast cancer, two had prostate cancer, two had multiple myeloma, one had medulloblastoma and one had an adenoid cystic salivary gland tumour. The mean interval from initial cancer diagnosis to development of the syndrome was 4.32 years. Twelve out of 13 patients had had prior chemotherapy with two or more lines of treatment (with a median of two lines), indicating this condition tended to present late in the course of disease in our patients. Four patients developed bilateral symptoms, and in two of these cases the metastatic lesion was in the base of the skull. Eleven out of 13 patients had positive signs on imaging. Nine out of 13 patients received palliative radiotherapy, with clinical response in eight patients. CONCLUSION Patients with malignancy presented with NCS late in the disease trajectory, often after multiple lines of treatment. In our cohort of patients, 84% had positive imaging signs to aid diagnosis, and 77% had resolution of numbness with palliative treatment.
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Affiliation(s)
- Neetu Tejani
- Department of Radiation Oncology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
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Abstract
This article reports an unusual presentation wherein the first evidence of distant failure from a locally controlled, recurrent skull base chordoma was a metastasis to the mandible. We present a case report from a tertiary-care academic skull base referral center and a review of literature. A 33-year-old woman with a locally recurrent spheno-occipital chordoma that was stabilized with multimodality therapy presented with a right mandibular mass. Immunohistochemical stains demonstrated the tumor cells staining positive for vimentin, cytokeratin, epithelial membrane antigen (EMA), and S100 consistent with metastatic chordoma. Positron emission tomography-computed tomography imaging further revealed widespread distant failure. Chordomas are rare tumors with only four previous reports of metastasis to the mandible. This is the first presentation of a mandibular metastasis from a spheno-occipital chordoma. We present a review of literature and summarize the demographic, clinical, pathological, treatment-related data, and discuss follow-up information from previous reports of metastatic chordomas to the mandible.
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Affiliation(s)
- Bridget Loehn
- Department of Otolaryngology-Head Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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