Head and neck manifestations of distant carcinomas

An unusual case of melanoma metastasis in the buccal space: learning by mistakes to distinguish it from salivary neoplasms

BACKGROUND

The buccal space is an unusual location of malignancies. We report here the case of a woman with a melanoma metastasis in buccal fat pad, to evaluate the imaging features which might lead to the correct, although uncommon, diagnosis.

CASE PRESENTATION

A 71-year-old woman presented with a painless visible swelling of the left cheek. MRI revealed the presence of a solid lesion located in the buccal fat pad with features suggestive of malignancy. It showed T1 hyperintensity and T2 hypointensity, and restriction of diffusion. Histological examination showed neoplastic cells compatible with melanoma.

DISCUSSION

The lesion features (T1 hyperintensity and T2 hypointensity) initially lead our team to believe that there was a hemorrhagic component, possibly a residue of the biopsy. However, when associated with other malignancy features, such as low apparent diffusion coefficient (ADC) values and contrast enhancement, they should evoke the suspect of melanoma, provided that no biopsy was performed and no trauma occurred in the 3-7 days before.

Breast cancer metastases to the head and neck: Case series and literature review

Breast cancer is the most common cancer in women and is the second most common cause of cancer-related death. Despite the relatively high prevalence of this disease, breast cancer manifestations in the head and neck are relatively rare. Supraclavicular lymphadenopathy and bony metastases to the mandible and maxilla are the most common manifestation of breast cancer in the head and neck. Head and neck metastases are the first presentation of distant disease in approximately one-third of cases. The prognosis of breast cancer with distant metastases to the head and neck is generally poor, and the management of these lesions is controversial. Overall extent of disease and individual patient prognosis must guide treatment decisions. Atypical cases including maxillary sinus mass, jugular foramen mass, and dermal metastases are presented. Metastatic breast cancer is a rare diagnosis in the head and neck, yet metastatic disease from an infraclavicular primary deserves inclusion on any comprehensive differential diagnosis list. In women, breast carcinoma is the most common infraclavicular primary to metastasize to the head and neck.

Mandibular metastases as first clinical sign of an occult male breast cancer

A 73-year-old man presented with a painful swelling of the left temporomandibular joint with no other symptoms. Panoramic radiography showed an osteolytic lesion in the left mandibular body, while magnetic resonance imaging provided the most accurate view of an osteolytic lesion in the left condyle. Skeletal scintigraphy showed increased uptake in the mandibular anatomical area. A diagnosis of metastatic breast adenocarcinoma was made from mandibular biopsies which proved to be ductal carcinoma, with no evidence of any other metastases. Clinicopathologic features of this case are reviewed.

Craniofacial metastases: a 20-year survey

In this study we analysed the long-term prognosis of 52 patients with distant metastases to the craniofacial area. All patients were treated in our department between 1989 and 2009. Possible predictive factors for the overall survival prognosis like age, gender, histopathological type of the metastasis, location and tissue structure of the area in the head and neck region, time between primary tumour and metastasis and the therapy were evaluated. 62% of the patients with distant metastases in the craniofacial area were male (32/52), the average age was 63 years. Adenocarcinoma was the most common histological type (20/52) and lung (12/52), malignant melanoma of the skin (9/52) and breast (8/52) the most common primary tumour site. In 35% of all patients, the primary tumour was not known at the time of the diagnosis of the craniofacial metastasis, this number reduced to 17% without the patients with a CUP syndrome. Patients survived an average of 14.4 months after manifestation of the metastases and 43.4 months after the manifestation of the primary tumour.