Metastatic Neuroblastoma to the Mandible of Children: Report of Two Cases and Critical Review of the Literature.

Neuroblastoma is the most common extracranial solid cancer of infancy, occurring mainly in the adrenal gland, with high metastatic potential. However, involvement of the head and neck region is rare. Here, we present two cases of metastatic neuroblastoma of childhood, in which a mandibular swelling was the first sign of disseminated disease. Case 1 describes a 4-year-old boy with a 2-week history of painful swelling in the left mandibular region, body soreness and weakness. Panoramic radiography and computed tomography showed a destructive lesion in the left mandibular ramus. Case 2 describes a 3-year-old boy with a 1-month history of swelling in the right mandibular area. Panoramic radiograph and cone-beam computed tomography showed a destructive lesion in the right body and ramus of the mandible, displacing tooth germs, with the destruction of vestibular and lingual bone cortices. In both cases, microscopic analyses revealed a diffuse proliferation of small, round, and blue cells with hyperchromatic nuclei and scant cytoplasm. While Case 1 was more undifferentiated, Case 2 presented eosinophilic areas suggestive of neuropil. A large immunohistochemical panel was performed, showing expression of neural markers such as CD56, neuron-specific enolase (in Case 2), chromogranin, and synaptophysin. Both lesions presented a high proliferation index (Ki67 > 70% and 80%, respectively). Positron emission tomography-computed tomography revealed ipsilateral adrenal primary lesions in both cases, with multiple bone metastatic lesions. Besides the mandible, multiple sites of the axial and appendicular skeleton were affected. Treatment consisted of induction chemotherapy, adrenalectomy, consolidation chemoradiotherapy, and post-consolidation therapy.

Primary adenocarcinoma of the colon with metastases to the mandible and liver: a case report / Adenocarcinoma primario de colon con metástasis en mandíbula e hígado: reporte de un caso

Metastatic lesions to the mandible may be originated from primary tumors elsewhere in the body. However, metastatic colonic carcinomas to this bone have been described infrequently. We report the case of a 71-year-old man with an adenocarcinoma in the sigmoid colon with liver metastasis. The patient underwent chemotherapy with indication of sigmoidectomy and retroperitoneal lymphadenectomy. One year and four months after the first metastatic diagnosis, the patient presented a tumor mass in the body and branch of the right mandible. Histopathological and immunohistochemical analysis with monoclonal antibodies specific for CEA, CK20, CDX-2, and vilin were compatible with the diagnosis of moderately differentiated metastatic adenocarcinoma with colonic origin. However, due to the wide spread of the disease, the patient died four months later. Tumor markers have been applied in clinical practice to assist in the diagnosis and to help guide prognosis, staging and treatment of cancer. The management of metastatic lesions remains a controversial issue and the development of new and more specific markers of gastrointestinal differentiation that may promote early diagnosis, are of continuous interest.

Las lesiones metastásicas de la mandíbula pueden surgir de los tumores primarios en cualquier partes del cuerpo. Sin embargo, el carcinoma metastásico de colon de este hueso se han reportado con poca frecuencia. Presentamos el caso de un hombre de 71 años de edad, con un adenocarcinoma de colon sigmoide con metástasis en el hígado. El paciente fue sometido a quimioterapia con indicación de sigmoidectomía y linfadenectomía retroperitoneal. Un año y cuatro meses después de la emisión del primer diagnóstico de la metástasis, el paciente presentaba una masa tumoral en el cuerpo y rama de la mandíbula derecha. El análisis histopatológico e inmunohistoquímico con anticuerpos monoclonales específicos para CEA, CK20, CDX-2, y vilin fueron compatibles con el diagnóstico de adenocarcinoma moderadamente diferenciado metastásico originario en el colon. Sin embargo, debido a la amplia propagación de la enfermedad, el paciente murió cuatro meses más tarde. Los marcadores tumorales se han aplicado en la práctica clínica para ayudar en el diagnóstico y ayudar a orientar el pronóstico, la estadificación y tratamiento del cáncer. Gestión de las lesiones metastásicas sigue siendo un tema controvertido, y el desarrollo de marcadores nuevos y específicos que promueven la diferenciación del diagnóstico precoz gastrointestinal, son de interés continuo.

Validating of the pre-clinical mouse model for metastatic breast cancer to the mandible.

Metastatic breast carcinoma has a great tendency to spread to the mandible. It is concomitantly associated with bone destruction, food intake disorder, and a poorer prognosis. Appropriate animal models need to be developed for a better understanding of the mechanisms underlying the metastatic process of breast cancer cells to mandible and to test the effects of potential lead compounds. Here, we assessed the metastasis model of intracardiac injection using luciferase-transfected metastatic breast cancer cells (MDA-MB-231Luc+) by determining the incidences of metastasis, mCT images, and histopathological results. A high bioluminescence signal mainly detected mandibular lesions with less frequent distal femora and proximal tibiae lesions. Extensive mandibular bone destruction occurred in nude mice grafted with metastatic breast cancer cells. This type of animal model might be a useful tool in assessing therapeutic implications and the efficacy of anti-cancer drugs for osteolytic cancers.

Validating of the pre-clinical mouse model for metastatic breast cancer to the mandible

Metastatic breast carcinoma has a great tendency to spread to the mandible. It is concomitantly associated with bone destruction, food intake disorder, and a poorer prognosis. Appropriate animal models need to be developed for a better understanding of the mechanisms underlying the metastatic process of breast cancer cells to mandible and to test the effects of potential lead compounds. Here, we assessed the metastasis model of intracardiac injection using luciferase-transfected metastatic breast cancer cells (MDA-MB-231Luc+) by determining the incidences of metastasis, mCT images, and histopathological results. A high bioluminescence signal mainly detected mandibular lesions with less frequent distal femora and proximal tibiae lesions. Extensive mandibular bone destruction occurred in nude mice grafted with metastatic breast cancer cells. This type of animal model might be a useful tool in assessing therapeutic implications and the efficacy of anti-cancer drugs for osteolytic cancers.

Mandibular metastasis of adenocarcinoma from prostate cancer: case report according to epidemiology and current therapeutical trends of the advanced prostate cancer.

Prostate cancer represents the most frequent non-cutaneous neoplasia in males. This type of neoplasia can develop peculiar patterns of evolution, presenting, in many cases, precocious relapses and metastasis. Bone metastasis in the mouth is extremely rare, and represents 1% of all malignant mouth neoplasias. The aim of the present study is to report a clinical case of bone metastasis in the mandibular region associated with a tumoral prostate adenocarcinoma, as well as to discuss connected aspects about diagnosis, prognosis and integrated treatment of this condition.

Mandibular metastasis of adenocarcinoma from prostate cancer: case report according to epidemiology and current therapeutical trends of the advanced prostate cancer

Prostate cancer represents the most frequent non-cutaneous neoplasia in males. This type of neoplasia can develop peculiar patterns of evolution, presenting, in many cases, precocious relapses and metastasis. Bone metastasis in the mouth is extremely rare, and represents 1% of all malignant mouth neoplasias. The aim of the present study is to report a clinical case of bone metastasis in the mandibular region associated with a tumoral prostate adenocarcinoma, as well as to discuss connected aspects about diagnosis, prognosis and integrated treatment of this condition.

Metástasis en cóndilo mandibular: presentación de un caso clínico / Mandibular condyle metastasis: report of a clinical case

Las metástasis bucales constituyen un grupo de baja frecuencia pero de gran importancia en particular por su localización. Según datos bibliográficos internacionales, representan del 1 por ciento al 8 por ciento de todas las neoplasias malignas bucales. Pueden localizarse tanto en los tejidos blandos como en los huesos maxilares (84 por ciento) prevaleciendo en la mandíbula, principalmente en el área molar, seguida del sector premolar. La localización condilar es rara. En los últimos 55 años sólo han sido reportados 48 casos. Dado que no existen patrones clínicos ni radiográficos que permitan caracterizar las lesiones, estas patologías suelen en un principio ser tratadas erróneamente como desordenes propios de la articulación temporo mandibular (ATM).Se presenta un caso clínico de a una paciente de sexo femenino de 36 años con antecedentes de adenocarcinoma de recto que presenta una metástasis en cóndilo bajo la apariencia clínica de un cuadro de disfunción de la ATM. Corresponde al tercer caso reportado en la literatura.

Oral metastases are a group of low-frequency lesions but important particularly because of its location. According to international bibliographic data represent 1% to 8% of oral malignancies. They can be located both in soft tissues and in the jaws (84%). Prevails in the mandible, mainly in the molar area, followed by the premolar region. The condylar location is extremely rare. Since the clinical and radiographic features are not characteristic, these lesions are often erroneously treated initially as temporomandibular joint (TMJ) disorders.In the last 55 years only 48 cases have been reported. We present a 36-years-old female patient with antecedents of rectal adenocarcinoma treated two years ago, having a metastasis in the mandibular condyle with clinical appearance of TMJ dysfunction.This is the third case reported in the literature.

Clinical, histological, and immunohistochemical features of a mandibular metastasis from a primary cardiac angiosarcoma.

Primary cardiac angiosarcoma is an extremely rare malignant tumor. Distant metastases are common at the time of diagnosis but have never been reported in the jaw. A 45-year-old female patient with primary cardiac angiosarcoma was referred for dental care due to pain in the mandibular alveolar ridge. Oral examination revealed a red-violet lesion that was soft on palpation and had been present for 3 months. Histological analysis confirmed the diagnosis of metastatic cardiac angiosarcoma. The patient died of multiple metastases.

Leiomyosarcomas of the oral cavity: report of a radiation-associated and a metastatic case.

BACKGROUND: Leiomyosarcoma is rare in the oral cavity, where it may arise as primary, radiation-associated, or metastatic tumor. This article reports two cases of oral leiomyosarcoma, discussing the range of clinicopathological features and the significance of these presentations. CASE REPORT: One case is a radiation-associated leiomyosarcoma arising in the tongue of a 71-year-old male occurring 22 years after radiation therapy for tonsil squamous cell carcinoma that was surgically treated. The other one is a mandible metastasis from a retroperitoneal widespread leiomyosarcoma in a 69-year-old man, who was treated by surgery and chemotherapy but died from the disease. DISCUSSION: Post-radiotherapy sarcomas of the oral cavity and oral metastasis from soft tissue sarcomas are very uncommon, but based on patient's clinical history, they should be considered by oral health care providers in order to allow an early diagnosis and proper and timely management. Finally, to the best of our knowledge, this seems to be the first reported case of tongue leiomyosarcoma arising in a previously irradiated field.

Metastatic adenocarcinoma involving several bones of the body and the cranio-maxillofacial region: a case report.

Malignant tumours that have metastasized to the oral and maxillofacial region from distant sites account for only 1% of all malignancies of the jaw. These metastatic tumours are most often located in the mandible, and the majority of these in the molar region. The most common primary sources of metastatic tumours found in the oral region are the lung, kidney and prostate gland for the males, and the breast, genital organs and kidneys for females. The exact location of the primary tumour, however, is often difficult, sometimes impossible, to identify. We present the case of a 51-year-old woman with metastatic adenocarcinoma involving the condyle and mandible, and other bones of the body. The oral presentation of the metastasis was the source of the definitive diagnosis.

Clinico-pathologic conference: case 4.

A 45 years old male patient presented with an asymptomatic right mandibular mass that extended from the angle to the premolar area. It had been present for 3 months at the time of the initial presentation. Panoramic radiograph revealed an ill-defined unilocular radiolucency. Previous dental treatment included molar extractions and antibiotic therapy. Considerable bleeding was encountered during incisional biopsy.

Breast adenocarcinoma mimicking temporomandibular disorders: a case report.

AIM: The aim of this report is to present a case of a metastatic lesion in the mandible originating from a breast adenocarcinoma that was initially diagnosed as temporomandibular disorder (TMD). The role of the dental practitioner in the diagnostic phases is also discussed. BACKGROUND: It is not uncommon to see a patient who complains of what seems to be a TMD but who in reality suffers from a systematic disease, dental infection, or neoplasia. Although metastases to the head and neck are uncommon, it should always be considered among the differential diagnoses of lesions. REPORT: A 42-year-old female presented with pain and swelling in the right temporomandibular joint (TMJ) previously diagnosed as TMD. Further clinical, radiological, and histological examinations coupled with a history of adenocarcinoma of the breast lead to a final diagnosis of a metastatic lesion in the right TMJ region. SUMMARY: In most patients who present with an oral metastasis the distant primary tumor has already been diagnosed and treated. Occasionally the discovery of an oral metastasis leads to the detection of an occult primary malignancy elsewhere in the body. Thus the dentist should be able to perform an adequate diagnosis and play an important role in the diagnostic phase of care that can lead to a useful palliation and an enhanced quality of the patient's life. CLINICAL SIGNIFICANCE: In order to avoid the pitfalls so common in evaluating patients with TMJ pain, the clinician must perform a complete and critical review of the medical history along with a comprehensive examination. The challenge is to know and evaluate the differential diagnosis. Failure to do so can result in a misdiagnosis which may lead to unnecessary care, long-term therapy without clinical resolution, or potentionally death.

Mandible metastasis as the first sign from primary adenocarcinoma of the lung.

Adenocarcinoma of the lung that metastasizes to the mandible is very uncommon; only a few cases have been described in the English-language literature. This article presents a metastasis from adenocarcinoma of the lung affecting the mandible of a 64-year-old woman, in which the first discovered metastatic lesion was detected before the primary tumor. The immunoreactivity for human thyroid transcription factor-1 (TTF-1) in the oral lesion was essential for determining the site and type of the primary tumor, as the patient showed no clinical or radiographic evidence of a tumor in the thyroid gland. After the primary tumor in the lung was diagnosed, radiotherapy and chemotherapy were initiated; unfortunately, the patient died two months after the start of treatment. This article emphasizes the importance of a well-conducted examination for diagnosing metastatic oral lesions.

Oral metastasis of a hepatocellular carcinoma.

Hepatocellular carcinoma is a relatively common tumor that etiologically is closely linked to previous hepatitis B infection. Oral metastatic hepatocellular carcinoma is very rare, with only 61 cases reported in the literature. We describe a case of hepatocellular carcinoma metastatic to the anterior mandibular gingivae of a 60-year-old man. The patient also exhibited tumor metastases to the lungs, left knee, little finger of the left hand, scalp, and the skin of the neck. He died 6 months after the diagnosis of the oral metastasis because of systemic tumor dissemination.

Oral metastasis of breast carcinoma diagnosed by fine needle aspiration cytology. A case report.

BACKGROUND: Fine needle aspiration cytology (FNAC) is an important technique in the diagnosis of oral and maxillofacial conditions. The purpose of the present paper is to report a case of oral metastasis of breast carcinoma diagnosed by FNAC. CASE: A 45-year-old, black woman was referred for evaluation of symptomatic swelling in the left mandible. The medical history revealed that the patient had undergone extensive surgery to remove a lobular carcinoma. She had finished chemotherapy treatment about 5 months earlier. Due to the main diagnostic considerations of metastatic and inflammatory disease, FNAC was performed. The cytologic picture was consistent with a metastatic glandular neoplasm. CONCLUSION: FNAC is a safe, reliable, cost-effective and easy procedure and sometimes eliminates the need for open biopsy.

Mandibular metastasis of follicular thyroid carcinoma. Case report.

Thyroid carcinoma mandibular metastasis are not very frequent and the cases described in literature are few. Due to its bloodstream dissemination, most of them are a consequence of the follicular variant of thyroid carcinomas. A case is presented and a review of the clinicopathologic characteristics of the lesion is made, so the oral and maxilofacial surgeon can recognize it, make a correct differential diagnosis with other mandibular radioluciencies and in consequence, carry out an adequate treatment.

Oral metastasis of telangiectatic osteosarcoma.

Metastases of osteosarcoma in the mouth are rare, and only few cases have been described. We present a case of telangiectatic osteosarcoma of the femur in a 15-year-old girl, who developed metastases in the humerus, lungs and retromolar area 4 years after initial diagnosis and treatment. The girl died 2 months after the diagnosis of metastases despite treatment with chemotherapy. This report emphasizes that telangiectatic osteosarcoma has a very poor prognosis, particularly when multiple metastases develop.