Neoplasms metastatic to the mouth, jaws and surrounding tissues

Lytic lesion of the mandible revealing a metastatic breast cancer

INTRODUCTION AND IMPORTANCE

Breast cancer is the most common cancer in women and the second leading cause of cancer-related death. Breast cancer manifestations in the head and neck are relatively rare, have greater predilection for the jaws than for soft tissues. Metastasis in the oral cavity account for only 1 to 3 % of all oral malignant lesions. Regardless of the rare occurrence of metastatic lesions to the jaw, it should be taken into consideration in the individuals with a history of malignancy.

CASE PRESENTATION

The article reports a rare case of metastatic lesion of breast cancer to unilateral mandibular ramus region. The 66-year-old female patient was complaining of pain and swelling in the right mandible angle. She was referred to our department by her oncologist with the differential diagnosis of osteonecrosis or metastasis. She had undergone radical mastectomy for invasive lobular carcinoma of the left breast without adjuvant treatment. Oral cavity examination did not reveal the existence of any ulcer or fistula. Based on the patient's medical history and paresthesia of the lower lip and chin, the metastatic disease was highly suspected. The patient was referred to her oncologist for chemotherapy treatment before any invasive surgical management.

CLINICAL DISCUSSION

Breast cancer (BC) is the most common cancer affecting women globally. Bone is the most common site of metastasis in BC patients, with up to 75 % of stage IV BC patients developing skeletal metastasis. The frequent metastatic sites of bone are spine, ribs, sternum, femur, pelvis. Breast carcinoma metastasizes to the jaw bones are uncommon.

CONCLUSION

The diagnosis of metastasis to the oral cavity is a significant challenge to the clinician due to the lack of pathognomonic signs and symptoms. The general dentist or dental specialist should maintain a high level of suspicion while dealing patients with a history of cancer.

Metastatic gallbladder cancer presenting as numb chin syndrome: A case report and literature review

Gallbladder cancer (GBC) is an uncommon malignancy that is highly aggressive in the advanced stages. However, it rarely metastasizes to the mandible. Numb chin syndrome (NCS) is a rare neurological manifestation associated with various underlying causes, including occult primary cancers and distant metastases. It is often considered to be a significant indicator of malignancy, and thorough investigation is essential in the presence of unclear etiology. The current study reported on the case of a 69-year-old Japanese woman who presented with numbness and mild pain in the lower lip and chin area for three months. No other systemic symptoms were observed. Immunocytochemical examination revealed the presence of an adenocarcinoma and TNM staging as per the Union for International Cancer Control and the American Joint Committee on Cancer guidelines confirmed stage IVb GBC. Comprehensive full-body positron emission tomography-computed tomography examination using 18F-fluoro-2-deoxy-D-glucose revealed additional bone and soft-tissue metastases. Palliative chemotherapy and radiation treatment were initiated based on the advanced stage of disease at the time of diagnosis. However, the patient succumbed to multiple organ failure six months later. The simultaneous occurrence of GBC, mandibular metastasis and NCS is rare and associated with poor prognosis. Despite the widespread nature of the disease, it can often manifest as non-specific oral symptoms without any systemic indications. The current study emphasizes the critical importance of timely confirmatory testing for accurate diagnosis and initiation of appropriate management for such complex conditions.

Lung Cancer Cells Infiltration into a Mandibular Follicular Cyst

Introduction

The oral cavity is a rare site for other organs' tumor metastases. The incidence rate ranges from 1% to 3% of all oral malignancies. Metastases more frequently localize in the mandible, especially in the molar area. Metastases within odontogenic cysts are extremely rare, thus in the literature, only a few cases have been reported. The follicular cyst is one of the most frequent cysts of the jaws. Radiologically it shows as a unilocular lesion with a sclerotic border, characterized by a homogenous radiolucency that incorporates the crown of the unerupted tooth.

Methods

A 76-year-old female patient, affected by stage IV of lung adenocarcinoma, reported pain on the left mandible border, alongside lip dysesthesia. The ortho-panoramic radiograph showed a follicular cyst in the posterior left side of the mandible, with involvement of the ascending branch region. The cyst was surgically removed together with the impacted tooth. A histopathological examination of the specimen confirmed the diagnostic suspect of a follicular cyst, but in the cystic wall, focal infiltration of epithelial neoplastic cells was also found. The immunohistochemical analysis showed the presence of three different markers: CK 7+, TTF1+/-, and P40-. These markers identify the cells as metastatic lung carcinoma.

Results

Secondary tumor spreading in the jaws' area is rare (3% of all malignant lesions). Despite odontogenic cysts can undergo a dysplastic transformation (affecting the epithelial covering in ≤1% of the cases), infrequently these neoplastic cells can be related to secondary tumor spreading in a cystic wall. This report describes a metastatic localization within a mandibular follicular cyst.

Conclusions

Malignant cancers' metastasis in the oral district remains a rare and unexplored condition, especially when metastases are located in odontogenic cysts. In this circumstance, surgical removal and histopathological examination are strongly recommended.

Breast carcinoma metastasis to the cheek: a case report

BACKGROUND

Breast carcinoma is a common tumor in women, but it rarely metastasizes to the oral region. Furthermore, metastases to the oral region occur mainly to the maxillary and mandibular bone and rarely to soft tissue.

CASE PRESENTATION

We describe a case of breast cancer metastasis to the buccal area. Examination of the right buccal mass of a 66-year-old Japanese woman was suggestive of breast cancer metastasis, and a breast lump was detected. Since receiving hormone-based treatment, the patient has survived more than 5 years and is now in remission.

CONCLUSIONS

An oral metastatic lesion may be the first sign of breast carcinoma; oral surgeons should be aware of this possibility.

Fluorodeoxyglucose positron emission tomography/CT for primary malignant intraosseous neoplasms of the mandible

Primary intraosseous malignant neoplasm of the mandible is a very rare entity. There are few publications regarding fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for primary intraosseous neoplasms of the mandible. FDG PET/CT scans from 10 patients with primary malignant neoplasm of the mandible were retrieved from the Picture Archiving and Communication System database, and image findings were analyzed with correlation to contrast-enhanced diagnostic CT and surgical pathology. Accuracy of the FDG PET/CT findings was evaluated with respect to uptake intensity, lesion extension to adjacent soft tissue, lymph node and distant metastasis. All untreated primary mandible neoplasms demonstrated high FDG avidity on PET imaging. Most mandible lesions extended beyond the bones and involved perimandibular soft tissue. FDG PET/CT imaging showed improved sensitivity and specificity compared with that for CT for lymph node staging in 3 cases, with discordant findings between diagnostic CT and PET/CT. FDG PET/CT identified 4 distant metastases, which were not documented prior to PET/CT. The results suggested that FDG PET/CT was a valuable image modality to demonstrate all primary and metastatic lesions of primary malignant neoplasm of the mandible, to define perimandibular soft tissue involvement, and more accurately stage/restage the disease than diagnostic CT.

Gastrointestinal stromal tumor with maxillary metastasis: a case report and literature review

Gastrointestinal stromal tumors (GISTs) form commonly in the stomach, small intestine, colorectum, and esophagus. Metastatic GIST occurs in up to 50% of patients at presentation. The liver and peritoneal cavity are the most common (93%) metastatic sites; head and neck metastases are extremely rare. This report describes a unique case of a 77-year-old man who was diagnosed with a duodenal GIST that had been completely resected 15 years ago. Eleven years after complete resection, he presented with liver metastases and then received multiple lines of systemic therapy and ablative radiotherapy. In 2015, he presented to our oral and maxillofacial surgery department with a left exophytic maxillary mass that filled the left maxillary sinus. Incisional biopsy confirmed metastatic GIST. Further evaluation revealed extensive metastases in the patient's liver, lungs, spleen, abdominal wall, and lymph nodes. After adequate staging, the patient's condition was deemed palliative, and he was referred to the radiation oncology department for palliative treatment of the symptomatic maxillary lesion. To our knowledge, this is the first reported case of maxillary metastasis from a duodenal GIST. Inclusion of GIST in the differential diagnosis of jaw tumors in patients with nonoral malignancies is recommended. The literature on oral metastasis of GIST is reviewed and discussed in this case report.

Metastatic tumors in the oral region: a retrospective chart review of clinical characteristics and prognosis

OBJECTIVE

The study aimed to evaluate the clinical characteristics and outcomes of patients with metastatic tumors in the oral region.

STUDY DESIGN

We conducted a retrospective study of 14 patients (11 men and 3 women; median age, 70.5 years) with metastatic tumors in the oral region diagnosed between 2005 and 2018.

RESULTS

The primary tumors were located in the lung (n = 7), kidney (n = 3), renal pelvis (n = 1), thyroid (n = 1), stomach (n = 1), and bladder (n = 1). The most common histologic type of the tumor was adenocarcinoma (n = 6). The metastatic sites were the mandible (n = 7), tongue (n = 4), upper gingiva (n = 2), and maxilla (n = 1). In 6 patients, metastatic tumors were found in the oral region before the primary tumors were detected. The primary tumors were detected by positron emission tomography/computed tomography in 5 patients and by computed tomography alone in one patient. Seven patients received treatment for metastatic tumors in the oral region. The overall 1- and 5-year survival rates were 35.7% and 10.7%, respectively.

CONCLUSIONS

It is important to detect metastatic tumors in the oral region and primary tumors as early as possible. Radical or palliative treatment should be performed if possible, considering the condition of the primary tumor and its metastasis to other organs.

Mandibular Metastasis of a Recurrent Poorly Differentiated Urothelial Bladder Carcinoma

Metastatic lesions to the oral cavity are uncommon; they represent between 1 and 3% of all malignant oral neoplasms. In this article, we report a rare case of metastatic urothelial bladder carcinoma in the mandible detected on oral radiographic images and confirmed with multiple imaging modalities. A 67-year-old woman presented to our clinic suffering from pain in the right side of the mandible with a mild swelling. Panoramic radiograph revealed an ill-defined relatively radiolucent lesion in the right mandibular premolar-canine region presenting with permeative changes. Cone-beam computed tomography showed a relatively hypodense lesion with demineralization, interruption of the buccal cortices, and slight thickening and sclerosis of the buccal cortical bone. The patient was referred for further evaluation including additional advanced imaging radiographic techniques (MRI and PET scan) and clinical and histopathological examinations that lead to a final diagnosis of metastatic lesion from an underlying urothelial bladder carcinoma.

A Rare Case of Mucoepidermoid Carcinoma of Parotid with Mandibular Metastasis

Mucoepidermoid carcinoma is the most common malignant tumor of salivary gland. Majority of the salivary gland tumors arise in parotid gland with maximum being of benign nature. Although Mucoepidermoid carcinoma accounts for less than 10% of all tumors of the salivary gland, it constitutes approximately 30% of all malignant tumors of the salivary gland. It is characterized by a mixed pattern of the two main cell types: epidermoid and mucus-producing cells. Metastasis from salivary gland malignancy is infrequent and predominantly found in bone, lung, liver and lymph nodes. We are presenting a rare case of metastasis of mucoepidermoid carcinoma of parotid gland to the contralateral mandible.

Multidisciplinary Diagnostic and Surgical Management of Adenocarcinoma Gingival Metastases

Colon cancer is the third leading cause of cancer-related mortality worldwide and colon cancer metastases in rare sites, such as the oral cavity, lead to a worse prognosis. Oral metastasis is a rare clinical condition and it represents only the 1% among all oral cavity neoplasms. A multidisciplinary approach is recommended to carry out a correct diagnostic procedure that allows distinguishing between metastatic and primitive lesions of the oral cavity. Quick diagnosis and management are fundamental to take an appropriate action as early as possible, as usually the prognosis in patients with oral metastases of colon carcinoma is poor. Aim of this brief clinical report is to underline how the quick diagnosis and management of gingival lesions can be crucial for the correct management of those uncommon oral diseases and for having a better prognosis of the primary cancer.

Atypical Metastasis to the Head and Neck Region: An Analysis of 11 Patients

Objective

We present 11 patients with distant metastases to the head and neck from an infraclavicularly located primary tumor and discuss the management strategies including the clinical presentation, treatment modalities, and prognosis.

Methods

The retrospective data of the pathology reports and operation notes of 1239 patients who had undergone any kind of oncological surgical intervention between 2005 and 2017 were analyzed. All of the 11 patients included in the study were evaluated in our department's tumor board, and all patients with an operable lesion had undergone surgery. Inoperable patients were treated with chemotherapy and/or radiotherapy.

Results

The average age of the patients was 64.3 (48-88) years. Primary tumors were located in the lung (2), breast (2), ovary (2), prostate (2), kidney (1), and colon (1) and the primary lesion could not be determined in one patient. The most common symptom was newly occurred painless swelling (9/11, 81.8%) at the metastatic site. Four patients without any other distant metastases were operated. Of these four patients, two died during follow-up due to systemic disease, and the other two are alive and disease-free. Three of the seven inoperable patients were treated with chemotherapy and the other four with radiotherapy. The prognosis of this group was worse.

Conclusion

Although metastasis to the head and neck is not common, it is vital to keep in mind while approaching a patient with a lesion at the head and neck region especially if there is a history of lung, breast, and genitourinary cancers. Despite the poor prognosis, diminishing the tumor burden would increase the treatment success.

Metastasis of a Renal Collecting Duct Adenocarcinoma to the Oral Cavity After Tooth Extraction

Metastatic tumors rarely occur in the oral cavity. The most common of the oral metastases are lung cancers in males, and breast and genital cancers in females. The most common primary tumor metastasis to the oral cavity is from the lung, kidney, liver, prostate, and colorectal cancers. The metastatic lesions are similar to oral lesions such as pyogenic granuloma, giant cell lesions, gingival polyps, hemangioma, peripheral fibroma, and adenoid squamous cell carcinoma. Therefore, the diagnosis of primary tumors is challenging. To our knowledge, this is the first reported case to feature metastasis of a renal collecting duct adenocarcinoma to the oral cavity after tooth extraction.

Metastases from distant primary tumours on the head and neck: clinical manifestation and diagnostics of 91 cases

PURPOSE

The aim of this study was to evaluate which primary tumours metastasize on the head and neck region, identify the kind of clinical manifestation, the types of diagnostics that should be performed, and prove that the therapy appears possible and useful.

PATIENTS

As many as 91 patients with a distant metastasis on the head and neck were enrolled in this retrospective clinical study from January 2004 to September 2016. All the patients were evaluated for clinical symptoms, primary tumour, localization, diagnostics, and surgical procedure.

RESULTS

A total of 31 patients had asymptomatic swelling, 27 patients had symptomatic swelling, and nine experienced isolated pain without swelling. Most other symptoms were organ-specific. The most frequent localizations were the orbit (44 metastases), mandible (19), neck region (9), and skin (7). The most common primary tumours were breast carcinoma (44), bronchial carcinoma (12), and renal carcinoma (9). A biopsy was performed on 38 patients, a partial resection was done on 28 patients, extirpation on six patients, and a radical resection on 19 patients.

CONCLUSION

Distant metastases on the head and neck are rare and, therefore, pose a challenge for the oncologist and other involved disciplines. Most distant metastases occur within the first five years. Late metastases, especially in breast carcinoma, are still possible after 20 years. A surgical examination should be carried out if the findings are not clear due to multiple differential diagnoses. In particular, surgical options under palliative aspects should be examined.

Temporomandibular dislocation caused by pancreatic cancer metastasis: A case report

Metastasis-induced dislocation of the temporomandibular joint (TMJ) is rare. The present study describes a case of TMJ dislocation caused by metastasis from pancreatic cancer, and discusses this in the context of literature on occlusal abnormality and/or dislocation due to metastasis. In the present case, unilateral TMJ dislocation was suspected when the patient first presented; destructive bone changes were not observed on conventional radiographs, and magnetic resonance imaging (MRI) revealed a tumorous lesion. The present case suggests that healthcare professionals should consider whether a malignant disease is present in cases of occlusal abnormality and/or dislocation of the TMJ, and that, in patients with TMJ dislocation that cannot easily be repositioned, additional imaging examinations, including MRI, should be performed as soon as possible, regardless of whether destructive bone changes are present. Metastasis to the TMJ is typically associated with generalized skeletal metastasis in the final stage of malignancy. Therefore, it is crucial to consider the possibility of cervical spine metastasis in order to decrease the risk of cervical fracture when attempting reduction of a TMJ dislocation, particularly in patients with a history of cancer.

Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications

Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with osseous tissue and dense acellular cementum in a fibrous stroma. It is one clinicopathologic variant in a spectrum of related non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. Diagnosis primarily relies upon radiographic and clinical findings; unnecessary biopsy should be avoided, as inoculation with oral pathogens may precipitate chronic infection in these hypovascular lesions. Appropriate management of uncomplicated FCOD consists of periodic radiographic follow-up. Accordingly, it is important that both radiologists and clinicians performing endodontic interventions possess familiarity with this entity in order to prevent misdiagnosis and inappropriate intervention, which may result in a protracted clinical course. Lesions are usually asymptomatic in the absence of infection, typically discovered on routine dental radiographs or imaging performed for unrelated indications. Radiographically, the condition typically manifests as widespread non-expansile intraosseous masses of varying internal lucency and sclerosis that surround the root apices of vital teeth or edentulous areas in the posterior jaw. While all CODs share similar microscopic features, FCOD is distinguished by its multifocal distribution, involving two or more quadrants of the maxilla and mandible, often in a bilateral symmetric fashion. The vast majority of cases are sporadic, though few exhibit an autosomal dominant familial inheritance pattern. In this pictorial review, we discuss the radiologic characteristics of this entity, pertinent clinical and histologic features, differential diagnoses, and management options.

Metastatic carcinoma of the oral region: An analysis of 21 cases

Background

Metastatic carcinoma to the jaws and oral region are very rare, representing less than 1% of all oral tumors. Unfortunately, oral metastasis is usually manifestation of an advanced stage of primary cancer, and indicates widespread disease and poor prognosis.

Material and Methods

In this retrospective study, a total of 2039 patients with history of oral malignant tumor between 1980 and 2012 at Seoul National University Dental Hospital were evaluated. We analyzed the dental and medical records, and histopathological database of 2039 patients to assess the prevalence of oral metastasis of carcinoma in terms of sex and age, as well as, the most common origin of primary cancer, and prevalent site and histopathological type of metastatic carcinoma.

Results

Among 2039 patients, 21 (1.03%) were finally diagnosed with metastatic carcinoma of the jaws and oral region. Among the 21 patients, only 11 had a working diagnosis as oral metastasis upon clinical evaluation before performing a biopsy. The mean age at the time of diagnosis with a metastatic carcinoma was 56.86, and there was a male preponderance. Metastatic carcinoma was more frequent in the jaws than in the soft tissue, especially in the mandible compared to the maxilla. The most frequent primary site was the lungs, followed by the liver and breasts. The predominant histopathological types were hepatocellular carcinoma and adenocarcinoma. Patient outcomes indicated a poor prognosis with the time from the appearance of the metastasis to death was only 12 months.

Conclusions

According to these cases, oral metastases of carcinoma were exceedingly rare in Koreans. It can allow the clinicians take into account the possible presence of metastases and lead to early diagnosis.

Key words:Metastasis, jaws, oral region, mandible, Korean.

Metastasis to the Jawbones: A review of 453 cases

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.

Non-small-cell lung cancer metastasis to the oral cavity: A case report

We herein report an unusual occurrence of lung cancer metastasis to the oral cavity, reflecting the progression of the primary malignancy. A biopsy of oral lesions should always be performed, even of those located in uncommon sites, in patients with a history of uncontrolled lung cancer. Although this is a rare occurrence, our patient exhibited characteristics suggestive of oral metastasis from lung cancer, namely presence of lung adenocarcinoma, development of oral metastasis during the clinical course of the disease, accompanying multiple metastatic lesions, including to the brain and abdomen, and rapid fatal progression after the manifestation of oral metastasis. It is important to acknowledge the possibility of metastasis to the oral cavity in lung cancer patients with extensive metastases. Prompt diagnosis by biopsy of the lesion is required to establish the correct diagnosis.

Metastasis to the oral soft tissues: A review of 412 cases

The present review article analyzes the characteristics of metastases to the oral soft tissues from 1937 to 2015. An extensive literature search was performed. All variables such as age, gender, and primary and secondary tumor sites were analyzed. Metastases to the major salivary glands were not included in this review. In general, there were 412 metastatic lesions developed in the oral soft tissues. The male-to-female ratio was approximately 1.8:1. The mean age of the patients at diagnosis was 58. The lung was the most common primary site and the gingiva was the most common metastatic site. The greater part of the histological examination yielded adenocarcinoma. The diagnosis of a metastatic lesion in the oral cavity is a challenge to the clinicians due to the lack of pathognomonic signs and symptoms. Oral metastases usually occur in the advanced stages of cancers, and the interval between appearance and death is usually short. The oral soft tissue metastasis can be easily recognized compared to the metastasis of jawbones. Early detection of oral lesions is important in the case of being the first sign of a malignancy in other parts of body.

Metastatic clear cell variant of renal cell carcinoma of the mandible: Review and case report

A case of metastatic renal cell carcinoma (RCC) to the mandible is reported. A 22-year-old man consulted us for hypoesthesia of the right lower lip. Panorama X-ray film showed a radiolucent lesion in the right mandibular body. A diagnosis of a metastatic tumor to the mandible from the right kidney was made after evaluation by computed tomography and bone scan with Tc99 methyl diphosphonate which also revealed multiple bone metastases. Histologically diagnosis was clear cell variant of RCC. Patient has been put on radiotherapy for symptomatic treatment and a molecularly targeted drug. The therapy effectively stopped the progressive growth of oral and other metastatic lesions. The quality of life is relatively well maintained with tolerable adverse effects. The patient is still on our follow-up with an improved quality of life.

Metastatic Follicular Carcinoma Thyroid Masquerading as a Primary Jaw Tumor

Metastatic tumours of the oral cavity are rare constituting approximately one percent of all oral malignancies. These tumors are clinically significant as their appearance may be the first indication of an undiscovered malignancy at a distant primary site or the first evidence of dissemination from a known primary tumor. Thyroid cancer metastasizing to the jaw bones is a rare occurrence and very few cases have been described in literature. We present an additional case which in fact masqueraded as a primary jaw tumor. Metastasis to jaw bones is generally associated with poor prognosis with a majority of the patients dying within 6 months of diagnosis. Thyroid cancers however seem to be an exception to this, resectable solitary jaw bone metastasis from differentiated thyroid cancers is associated with a much better prognosis and therefore should be considered for metastatectomy.

Metastatic solid tumors to the jaw and oral soft tissue: A retrospective clinical analysis of 44 patients from a single institution

PURPOSE

Metastatic solid tumors to the oral cavity are rare, frequently indicative of an end-stage disease process, and associated with poor survival rates. We performed a 20-year retrospective clinical analysis of our institution's cases of solid metastases to the oral cavity, and investigated these patients' clinical outcomes.

MATERIAL AND METHODS

A retrospective study of patients with metastatic solid tumors to the oral cavity over a 20-year period (October 1996 to September 2015) was conducted at Memorial Sloan Kettering Cancer Center. Patients were selected if they had a histopathologically confirmed diagnosis. Demographic, pathologic, and clinical information were reviewed to identify patient outcomes.

RESULTS

A total of 44 patients with metastatic non-melanocytic non-hematopoietic tumor to the oral cavity were identified: 24 males and 20 females (39 adults and 5 children) with a mean age of 54.3 years. In all, 24 cases involved the jaw and 20 cases involved the oral soft tissue. Eight patients (18.2%) had oral cavity metastases as the first indication of an occult malignancy. In adult patients, the common primary sites were the lungs (n = 9, 20%), kidney (n = 7, 16%), breast (n = 5, 11%), and colon (n = 4, 9%); and in pediatric patients the adrenal gland (3/5) was the most common site. Of the adult patients, 33 (84.6%) died of disease. From the time of metastasis diagnosis, patients with jaw metastases had a median and mean survival of 12 months and 27.7 months, respectively. In comparison, patients with oral soft tissue metastases had a median survival time of 5 months, and mean of 8 months. One pediatric patient (20%) died of disease 8 months after metastasis diagnosis.

CONCLUSION

Metastatic solid tumors to the oral cavity can be the first sign of a malignancy. Pediatric patients with oral cavity metastases have a better prognosis compared to adult patients. In this series, adults with oral soft tissue involvement had shorter survival times compared to patients with jaw involvement.

Metastatic Tumours to the Oral Cavity: Report of Three Cases

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.

Mandibular metastasis of cholangiocarcinoma: A case report

Tumors metastasizing from distant regions to the oral and maxillofacial region are uncommon, comprising only 1%-2% of all malignancies. Cholangiocarcinoma is a malignancy that arises from cholangiocytes, which are epithelial cells that line the bile ducts. These cancers are difficult to diagnose and have a poor prognosis. In this paper, we report a rare case of mandibular metastasis of cholangiocarcinoma diagnosed at the primary site and discuss the radiographic findings observed in this case.

Colorectal Adenocarcinoma Metastasis to the Tongue

This case presentation examines a rare clinical entity: colorectal adenocarcinoma (CRC) metastasis to the tongue. CRC is among the least common tumors to metastasize to the oral cavity. Objectives for this case report are to (1) maintain a high index of suspicion for oral cavity tumors representing metastatic disease, (2) consider appropriate surgical and adjunctive interventions, and (3) recognize the significance of identifying the primary tumor via immunohistochemical staining. We present a case of a 57-year-old male with a history of stage IV rectal adenocarcinoma metastatic to the lung who presented to our clinic with a painful mass of the right lateral tongue that he noticed one month before. MRI of the neck revealed a mass involving the anterior two-thirds of the right tongue with irregular margins and an ipsilateral enlarged right jugulodigastric lymph node. The patient underwent right partial glossectomy with primary reconstruction and right modified radical neck dissection. Pathology confirmed poorly differentiated adenocarcinoma consistent with a colorectal primary with lymphovascular and perineural invasion. The tumor was staged as T2N1, and the patient was referred for chemoradiation. In this report, we discuss the presentation, diagnosis, and treatment of this uncommon disease, with a thorough review of the world literature.

A rare case of breast carcinoma metastasis to mandible and vertebrae

Oral cavity metastases are considered rare and represent approximately 1% of all oral malignancies. Due to their rarity and atypical clinical and radiographic appearance, metastatic lesions are considered a diagnostic challenge. This article presents a rare case of breast carcinoma with metastasis to mandible and vertebrae. A case is presented of a 40-year-old female patient with a history of breast carcinoma which was surgically treated approximately 2 years back. The diagnosis of metastatic breast carcinoma was confirmed by radiographic examination, bone scan and histopathologic findings. She was referred to radiotherapy department since it was not amenable to surgery due to metastasis in vertebrae. A high index of clinical suspicion of metastatic cancer is necessary when evaluating patients who complaint of jaw pain and swelling with a history of non-head and neck carcinoma.

Metastatic pancreatic adenocarcinoma to the mandibular condyle: a rare clinical presentation

Metastatic disease to the oral cavity is rare, representing only 1-8% of oral malignancies, and involvement of the mandibular condyle is even less prevalent. In a recent literature review of 796 cases of metastatic disease to the oral cavity, only 39 (13.8%) involved the condyle. This report is a unique case of metastatic pancreatic adenocarcinoma to the condyle. There are only 5 documented cases of metastatic pancreatic adenocarcinoma to the oral cavity, one of which metastasized to the condyle. This is an important case because metastatic lesions to the condyle may mimic temporomandibular joint disorders making clinical diagnosis and decision-making extremely challenging for the oral and maxillofacial surgeon. The requirement for arrival at an appropriate and prompt diagnosis is crucial for determining the most appropriate treatment regimens and improved outcomes. Additionally, in approximately 33% of cases, the oral metastatic lesion may be the first indication of an undiscovered distant primary tumor, making timely evaluation and treatment critical from an oncologic perspective.

Metastatic tumors to the jaws and oral cavity

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.

Metastatic tumors to the jaws and oral cavity

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.

Oral metastasis: a report of 23 cases

The authors describe a pooled analysis of 23 French patients presenting with oral metastasis between 1981 and 2008. The reviewed cases were collected from the medical records of two cancer institutes. The inclusion criteria were: the histology of the metastases must be known; the primary location must be known; metastasis and primary location must be physically separated; and oral primary locations were excluded. This sample represent 0.48% of all oral malignancies treated during the period. The sex-ratio was 2.3:1 in favour of men, the mean age was 64.5 years (±13.2). Lungs and kidneys represent 52.2% of the primary cancer locations. In most cases, the primary cancer was a carcinoma or an adenocarcinoma (82.6%). The most affected oral regions were the gingiva and alveolar mucosa (60.7%), followed by the tongue (17.9%). The mean survival was 16.6 months. This sample is characterized by the relative absence of specific symptoms and quite different distribution in primary sites. Even if oral metastases are rare, their semiological value necessitates the histopathological examination of any oral tumour, and a systematic search in all patients with cancer history.

Maxillofacial metastases: a retrospective review of one institution's 15-year experience

PURPOSE

Metastasis to the maxillofacial region is a rare occurrence. In our retrospective study of patients with metastasis to the maxillofacial region, the subjects were evaluated to define the clinical behavior patterns in response to the treatment given.

MATERIALS AND METHODS

A retrospective record review during a 15-year period (1990 to 2005) was conducted. The patients were selected for inclusion in the present study if they had histologically confirmed maxillofacial metastases.

RESULTS

In our retrospective study, during the 15-year period, 1,221 new patients with maxillofacial/oral cancer were seen and evaluated. Of these 1,221 patients, 26 (16 men and 10 women) were identified as having a histologically confirmed metastasis to the maxillofacial region, for an incidence of 2.1%.

CONCLUSIONS

Patients with metastasis to the maxillofacial region are often deemed to not be surgical candidates because of the extensive nature of the metastatic disease. We believe that surgical intervention plays a beneficial role in improving quality of life in a properly selected group of patients with metastasis to the maxillofacial region. In our case series, surgery was performed in about 50% of the patients, and palliation and radiotherapy were the most commonly used modalities.

Metastasis of a ductal breast carcinoma to the buccal mucosa of the mandible with tooth involvement

BACKGROUND

We present a metastatic tumour from the breast to the gingiva, with the rare finding of tooth invasion. Metastatic tumours to the oral region are uncommon. The breast is the most common primary site for metastatic tumours to the jawbones in women, with the mandible being most often affected.

CASE REPORT

We report the case of a 52-year-old Caucasian woman who presented with a swelling of the buccal mucosa in the molar region of the left mandible. Biopsy revealed a metastatic lesion, with involvement of the two adjacent molars. Immunohistochemical analysis ruled out other malignancies and confirmed the diagnosis of a ductal breast carcinoma origin.

DISCUSSION

Management in such cases should be in the context of the treatment of a metastatic disease that could prolong survival and improve quality of life, but is not curative. Tooth invasion has been described since 1910 for different primary malignancies with distant metastases to the oral cavity. This report seems to describe the second case in the literature of a metastatic breast carcinoma to the mandible with tooth invasion. Management in such cases should be in the context of the treatment of a metastatic disease that could prolong survival and improve quality of life, but is not curative.

Submental lymph node metastasis from invasive ductal breast carcinoma

This case report presents a 52-year-old woman with a submental swelling which arose 3 years after wide local excision and axillary lymphadenectomy for breast carcinoma. Histopathological examination after excision biopsy of this lesion confirmed the presence of invasive breast carcinoma in a submental lymph node. Computed tomography of the head, neck, thorax, abdomen and pelvis demonstrated multiple brain and pulmonary metastases. Further management was palliative and the patient died 5 months later. This is the first description of a breast carcinoma metastasising to the submental region. Metastatic breast carcinoma should be considered in the differential diagnosis of head and neck lymphadenopathy in patients with previously diagnosed breast carcinoma.

Metastasis of follicular thyroid carcinoma to the maxillary sinus

Thyroid carcinoma metastatic to the paranasal sinuses is extremely rare. We report a case of follicular thyroid carcinoma metastatic to the right maxillary sinus, with extension into the right side of the hard palate in a young lady. A radioactive iodine-131 (I-131) scan post total thyroidectomy revealed 0.8% uptake in the neck; the whole body scan revealed a functioning metastasis in the region of the right maxillary antrum. Pathological confirmation of metastasis was done by correlating the fine needle aspirate cytology with the thyroidectomy histology. The patient initially received 40 Gy of external beam radiotherapy, subsequently, she received 110 millicuries of I-131, followed by 50 millicuries 6 months later. She continues to be on follow-up on Eltroxin™ suppression and has remained disease free for the past 4 ½ years.

Metastatic carcinoma of gingiva mimicking pyogenic granuloma

A case of metastasis of lung carcinoma to mandibular gingiva in 46 year old man has been presented here. The patient suffered discomfort due to growth in the lower left molar region with occasional hemorrhage and increased mobility of his lower left molars. After extraction of the teeth curettage was performed and histopathological examination revealed similar findings to those found in the lung tumor. This case report emphasizes the need to recognize that the gingival masses similar to benign or inflammatory lesions may represent an initial sign of underlying distant malignant tumors.

Oral metastasis of lung cancer. A challenge for the clinician

BACKGROUND

Bone metastases are a major cause of morbidity in cancer patients. Jawbone metastasis from lung cancer is a rare condition that may occur in the late state of the disease.

CASE REPORT

We report the case of a 74-year-old male presenting with an oral asymptomatic swelling that had grown substantially over the last 2 months. Biopsy and histological examination revealed the presence of a metastatic lung cell adenocarcinoma.

DISCUSSION

Although metastases to the oral cavity are uncommon, clinicians may play a crucial role also in the diagnosis of primary tumors.

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.