Unusual malignant neoplasms occurring around dental implants: A report of 2 cases

Abstract

Osseointegrated implants are now commonplace in contemporary dentistry. However, a number of complications can occur around dental implants, including peri-implantitis, maxillary sinusitis, osteomyelitis, and neoplasms. There have been several reports of a malignant neoplasm occurring adjacent to a dental implant. In this report, we describe 2 such cases. One case was that of a 75-year-old man with no previous history of malignant disease who developed a solitary plasmacytoma around a dental implant in the left posterior mandible, and the other was that of a 43-year-old man who was diagnosed with squamous cell carcinoma adjacent to a dental implant in the right posterior mandible. Our experiences with these 2 cases suggest the possibility of a relationship between implant treatment and an inflammatory cofactor that might increase the risk of development of a malignant neoplasm.

Keywords: Carcinoma, Squamous Cell; Dental Implants; Mouth Neoplasms; Plasmacytoma.

Fig. 1. An enlarged erythematous mass is seen on the lingual vestibular area (arrows).

Fig. 2. A. A cropped panoramic radiograph reveals a periapical radiolucency in the left mandibular molar. B. A cropped panoramic radiograph shows a dental implant that was placed approximately 4 months after tooth extraction.

Fig. 3. A. A cropped panoramic radiograph shows ill-defined, permeative bone destruction in the area from the left lower premolar to the second molar. When compared with Figure 2A, the lesion has expanded into the mandibular canal. B. Infiltrative bone destruction and an enlarged soft tissue shadow (arrows) can be seen in the periapical view.

Fig. 4. A. A sagittal cone-beam computed tomographic (CBCT) image shows osteolytic destruction in the area of the left mandibular body and loss of cortication in the mandibular canal. B. Cross-sectional CBCT images demonstrate partial perforation and erosion of the buccal and lingual cortical plates.

Fig. 5. A. A histopathologic exam demonstrates diffuse proliferation of atypical plasmacytoid cells (H&E stain). Immunohistochemical staining revealed that the tumor cells were negative for CD20 (B), but positive for CD138 (C), a plasma cell marker. D. Of the two types of immunoglobulin light chain, only the kappa chain showed immunoreactivity to tumor plasma cells (A–D, original magnification 400×).

Fig. 6. A. A cropped panoramic radiograph shows bone destruction with an ill-defined border around the dental implants. B. A periapical radiograph shows an enlarged soft tissue shadow.

Fig. 7. A. Ultrasonographic images in B-mode show a well-demarcated heterogeneous mass (30 mm×15 mm) with localized bone destruction. B. Color Doppler sonograms show newly formed blood vessels supplying the interior and periphery of the mass.

Fig. 8. A. A representative photomicrograph shows invasion of dysplastic squamous cells into the underlying connective tissue (H&E stain, original magnification 40×). B. Tumor nests composed of atypical keratinocytes showing cellular pleomorphism, brisk mitosis, and dyskeratosis (H&E stain, original magnification 400×).