A jaw metastasis from the colon

Hidden colon adenocarcinoma diagnosed from mouth metastasis: case report and literature review

BACKGROUND

We report an unusual case of metastatic colon adenocarcinoma to the maxilla as an initial clinical sign of the disease, this being the second case reported in the palate. In addition, we show an extensive review of the literature, with clinical cases of adenocarcinoma with metastasis to the mouth.

CASE PRESENTATION

An 80-year-old man complained of "swelling on the palate" with a 3-week evolution time. He reported suffering from constipation and high blood pressure. The intraoral examination revealed a pedunculated, red, and painless nodule on the maxillary gingiva. Under the diagnostic hypotheses of squamous cell carcinoma and malignant neoplasm of the salivary gland, an incisional biopsy was performed. Microscopically, the columnar epithelium was observed forming papillary areas, neoplastic cells with prominent nucleoli, hyperchromatic nuclei, atypical mitotic figures, and mucous cells, being positive for CK 20, suggesting the provisional diagnosis of metastatic adenocarcinoma, probably of gastrointestinal origin. The patient was submitted to endoscopy and colonoscopy exams, and a lesion in the sigmoid region of the colon was observed. After a colon biopsy, a moderately differentiated adenocarcinoma was confirmed, establishing the final diagnosis of metastatic neoplasia of colon adenocarcinoma to the oral lesion. The literature review revealed 45 clinical cases of colon adenocarcinoma with metastasis to the oral cavity. To the best of our knowledge, it is the second case on the palate.

CONCLUSIONS

Colon adenocarcinoma with metastasis to the oral cavity is rare but should be included in the differential diagnosis of neoplasms of the oral cavity, even when there are no known primary tumors in some cases, and this may be the first indication of the presence of a tumor.

Metastatic tumors to the oral and maxillofacial region: a retrospective study of 19 cases in West China and review of the Chinese and English literature

PURPOSE

The aim of this article was to obtain an overview of metastatic tumors to the oral and maxillofacial (OMF) region, especially the differences in the constituent ratios of primary cancers between the United States and China.

PATIENTS AND METHODS

Clinical findings of 19 cases encountered in West China Hospital of Stomatology were summarized and the English and Chinese literature were reviewed and analyzed. The main clinical features of OMF metastases were summarized, with an emphasis on primary cancers' constituents.

RESULTS

The lung, breast, kidney, liver, and prostate were the top 5 common primary sites of cancer. However, there was a significant difference in the primary cancers' constituents between United States and China (P < .001). The breast, kidney, prostate cancers, and melanoma of skin were more frequent primary cancers in United States than in China, whereas that of the lung, thyroid, liver, esophagus, and the stomach were more common in China than in United States. The proportions of the OMF metastatic lesions originating in the lung, kidney, liver, thyroid, and esophagus in all OMF metastatic tumors were higher than the corresponding primary cancers' prevalent proportions.

CONCLUSIONS

The frequency of developing OMF metastasis is not always consistent with primary cancers' prevalence, which suggests that different cancers have different potentiality to develop OMF metastasis. Cancers of the kidney, liver, lung, thyroid, and esophagus were more likely to spread to the OMF region. In general screening of primary cancer, it would be helpful to take into account the metastatic potentiality of different cancers and primary cancers' prevalence in different countries in the case of occult primary.

Tumors metastatic to the mandible: analysis of nine cases and review of the literature

Metastases to the mandible are rare. In this article, nine cases of tumors metastatic to the mandible of various origins and locations, including metastasis to the condyle, are reported. The most common primary tumor was breast adenocarcinoma (three cases). The clinical features, diagnosis, and treatment of metastatic lesions, especially emphasizing clinical and radiologic aspects, are described, and a review of the literature is presented.

Neoplasms metastatic to the mouth, jaws and surrounding tissues

5% of all malignancies involve the oral cavity. One percent of these malignancies are secondary to neoplasms that are usually found below the level of the clavicles. As it is widely accepted that the jaws do not contain a lymphatic system, it is believed that metastases there occur via the blood stream, a fact that is supported by the occurrence of metastatic foci in areas where spongiosa and slowing of the circulation favour the entrapment of metastatic emboli. This however does not explain why most of the metastases occur in the lower jaw (and in particular in the premolar-molar area) and not in the maxilla, where the spongiosa is more abundant. Batson's plexus has also been mentioned as a possible route of metastasis to the head and neck, thus explaining why, in some cases of metastases, the lungs are not involved, as the blood has not been filtered through the pulmonary bed before reaching the head and neck. In our review of the literature we found 422 metastatic lesions in the mouth, jaws and the surrounding tissues in 365 patients equally divided between men and women. 56.5% of the cases were above the age of 50. In 228 cases there were other metastases as well, whereas in 114 cases the only metastasis found was the one under study. In 22% of the cases, the metastatic focus in our area was the first indication of the existence of an undiagnosed primary malignant tumour somewhere else.(ABSTRACT TRUNCATED AT 250 WORDS)

Metastatic adenocarcinoma of the colon presenting as periradicular periodontal disease: a case report

Metastases to the jaws account for only 1% of all malignant tumors of the oral cavity. Consequently the diagnosis of metastasis to the mandible requires a high degree of clinical suspicion and the use of a systematic diagnostic approach. In this case report a patient sought treatment for what appeared clinically and radiographically as periradicular periodontal disease. However, because the patient had a medical history of adenocarcinoma of the colon 5 years previously, metastasis to the jaws was included in the differential diagnosis. Metastasis to the jaws may resemble periodontal disease or many of the other benign and malignant conditions that affect the jaws, thus making the correct radiographic diagnosis difficult. Ultimately, histologic evaluation is essential to make a definitive diagnosis.

Metastatic colon carcinoma to the jaw: a case report and review of the literature

Presented is a case of adenocarcinoma of the cecum metastatic to the anterior mandible. The patient had a Duke's C2 cecal adenocarcinoma resected twenty months prior to her development of loose teeth, jaw pain, and jaw mass. A biopsy of the mass revealed metastatic adenocarcinoma, identical to her primary neoplasm. Metastatic carcinoma to the mandible is a rare event. A review of the literature reveals only nineteen cases of colon carcinoma metastatic to the jaw. When further subdivided, there is only one other case of cecal adenocarcinoma metastasizing to the jaw. Almost half of the other cases have been rectal carcinomas. Treatment of these patients has been uniformly unsuccessful, with life expectancy reported between one and seven months. The literature has shown that 5-FU and radiotherapy may produce palliation of symptoms. The patient presented here responded well to 5-FU and radiotherapy.

Metastatic breast carcinoma disguised as periapical disease in the maxilla

This article reports a case of breast carcinoma metastasis to the maxilla. The symptoms and original diagnosis pointed to periapical disease. A biopsy confirmed the secondary diagnosis. This may be the first reported case of metastasis to the maxilla.

Adenocarcinoma of the rectum metastatic to the oral cavity. Two cases and a review of the literature

Two cases of metastatic adenocarcinoma occurring in the oral cavity are presented. One patient experienced lip paresthesias and pain as the presenting complaint. The other patient developed a growth at the site of a recent tooth extraction, and had bony erosion of the adjacent maxilla. The literature on metastatic lesions to the oral cavity including mandible is reviewed. This problem has been described almost exclusively in the oral and dental surgery literature. The clinical symptoms and signs described here should suggest the possibility of metastatic tumor to the oral cavity, and may be the initial manifestation of malignant disease.

Metastatic adenocarcinoma from the colon to the mandible

Published reports of metastatic adenocarcinoma from the colon or rectum to the mandible are extremely rare. Only eight cases had been reported from 1884 to the time this article was written. A case is presented where a metastatic lesion was found to be histologically similar to the known primary tumor in the cecum. The patient first noted dental pain, isolated to his mandibular left second bicuspid, 10 months after a primary tumor was diagnosed. Subsequently, the tooth was extracted, and it was only after the extraction site failed to heal that a biopsy was performed which confirmed a metastatic lesion. Retrospective study of the preextraction radiograph confirmed the presence of a suspicious area in the osseous structure of the mandible at the time of extraction. It must be emphasized that in patients with a positive history of malignancy, metastatic disease must be considered in the differential diagnosis of oral and dental symptoms, and that need for biopsy should be considered with all surgical procedures, including simple extractions.

Metastatic adenocarcinoma to the mandible: report of case

A 40-year-old woman who had undergone a mastectomy of the right breast two years before was admitted in our department with metastatic malignant tumor of the mandible. The biopsy revealed the presence of the metastatic adenocarcinoma.