Metastatic Tumour to the Mandible - A Diagnostic and Management Dilemma

Jaw bone metastasis from Lung cancer as sole primary source: A systematic review

Background

Lung cancer is one of the leading causes of death worldwide. Lung cancer metastasis to oral region is very rare. Very few research work has been conducted till date to analyse the jaw bone metastasis from Lung cancer as the primary source. The goal of this research was to examine published cases of jaw bone metastasis from lung cancer as the sole primary source from 1st December 1961 to 31st December 2021 and to learn about their characteristics.

Material and Methods

An electronic search of the published English literature was performed in PubMed/ Medline, Scopus, Google Scholar, and Research gate databases, using keywords like ‘Lung cancer’, OR/AND ‘Lung carcinoma’, OR/AND ‘Metastasis’, OR/AND ‘Primary’, OR/AND ‘Source’, OR/AND ‘Oral cavity’ OR/AND ‘Jaw’, OR/ AND ‘Mandible’, OR/AND ‘Maxilla’, OR/ AND ‘Temporomandibular joint’, OR/ AND ‘Condyle’, OR/ AND ‘Ramus’, OR/ AND ‘Maxillary sinus’, AND Initial’, OR/ AND ‘Treatment’, OR/AND ‘Prognosis’, OR/ AND ‘Follow-up’, OR/AND ‘Recurrence’, OR/ AND ‘Survival rate’. We also searched all related journals manually. Reference list of all articles was also checked. Data extracted were tabulated and summarized.

Results

In total, we found 60 relevant publications with 66 patients in our research. The prognosis was poor, with a survival time of 1 week to 1.5 years. The most prevalent diagnosed metastatic lung cancer to jaw bones was adenocarcinoma and mandible was the predominant site.

Conclusions

Jaw bone metastasis from lung cancer is rare and has a bad prognosis. Because of their resemblance to other jaw problems and late clinical signs, these lesions go unnoticed the majority of the time, making detection difficult. More cases need to be published in order to raise awareness of these lesions and gain a better understanding of their characteristics.

Key words:Jaw bone, lung cancer, metastasis, primary, prognosis.

Metastasis in the mandible involving gingiva: An intriguing case with a perplexing pathology

Oral metastasis, although rare, tends to involve jawbones, particularly the posterior region of the mandible, and involvement of oral soft tissues, even when less likely, is most often seen on the gingiva and tongue. Clinically, the soft-tissue masses tend to mimic pyogenic granuloma, peripheral giant cell granuloma or an epulis and thus are difficult to diagnose and identify. The jaw bone is preferred by prostate carcinoma as a metastatic target. Prostate malignancy, which is more common in Western countries than in India, may be adenocarcinomas or carcinomas. Oftentimes, metastatic lesions develop in the alveolar region and are a cause for tooth mobility, yet, they tend to be detected only after extraction of the affected tooth. In such cases, the symptomatic presentation therefore, is vague and indicative of tooth mobility secondary to periodontal pathology unless, a detailed history and follow-up is done. We report a case of a male patient who presented to our department with a proliferative, painful, swelling postextraction of the left first molar region, and the lesion was seen at the extraction site as well as in the mandibular anterior tooth region. The swelling was associated with palpable lymph nodes. Orthopantomogram showed an irregular, radiolucent lesion extending from the lower left central incisor to the left first molar region in the mandibular alveolus. Incisional biopsy tissue came with provisional diagnosis of osteomyelitis or squamous cell carcinoma as the patient was a habitual bidi smoker for more than 20 years. Histologically, it was an undifferentiated tumor with tumor cells seen in deep connective tissue with a lack of lineage differentiation. An undifferentiated malignant tumor represents either a metastasis of unknown origin or a primary neoplasia without obvious cell line of differentiation. Immunohistochemistry (IHC) of undifferentiated tumors helps to categorize them into small round blue cell tumors or large cell tumors. The oral pathologist was perplexed as there was no mention of any other malignancy in the patient's history, which, however, was noted by the surgeons few days later. Hence, initially, a hematopoietic malignancy was suspected which was ruled out by IHC, and later, staining with cytokeratin 7 (CK7), CK-high molecular weight and P63 confirmed prostate metastases as all three were negative.