A retrospective study of six patients with mandibular metastatic carcinoma

Abstract

Mandibular metastatic carcinoma is a rare lesion that accounts for <1% of all oral malignancies. To provide greater experience in this field, the present study was conducted in which 6 cases of mandibular metastatic carcinoma were retrospectively reviewed. The origin of the lesions was the prostate in 2 cases, the lungs in 2 cases, the breast in 1 case and the thyroid gland in 1 case. The clinical and computed tomography features, surgical management and follow-up outcomes were investigated. The study indicated that surgeons should include the suspicion of metastasis in the differential diagnosis for mandibular tumor, particularly in patients who have a history of malignancy. A poor prognosis was associated with the examined patients. To extend the survival time as long as possible, a treatment strategy using multiple therapies, including segmental mandibulectomy, radiotherapy and chemotherapy, is recommended.

Keywords: computed tomography; differential diagnoses; mandibular metastatic carcinoma; survival; therapy.

Figure 1.

Computed tomography features of mandibular metastatic carcinoma. (A and D) Case 1: An osteoplastic lesion with a clear periosteal reaction; (B and E) case 3: An osteolytic lesion with a periosteal reaction; and (C and F) case 5: A radiolucent fibro-osseous lesion. (A, B and C show soft tissue windows, with a window width of 270 Hu and a window level of 35 Hu; D, E and F show bone windows, with a window width of 1,500 Hu and a window level of 400 Hu).

Figure 2.

Histological images. (A) Case 1: A mandibular metastatic prostatic adenocarcinoma, with crushed adenocarcinoma cells found within the bone; (B) case 3: A mandibular metastatic lung adenocarcinoma, in which adenoid structures and columnar epithelial cells with cellular nucleus division was observed; (C) case 5: A mandibular metastatic thyroid adenocarcinoma, with tumor cells arranged in nests and growing within the bone; and (D) case 6: Mandibular metastatic ductal breast cancer, with ductal carcinoma cell nests surrounded by tumor connective tissue within the bone. Original magnification, ×200.

Figure 3.

Immunostaining. (A) Case 1: The overexpression of prostate-specific antigen in the atypical cells of the prostatic metastatic adenocarcinoma specimen; and (B) case 5, immunostaining of thyroglobulin in the atypical cells confirming the diagnosis of thyroid metastatic adenocarcinoma. Magnification, ×200.