A UNIQUE PRESENTATION OF METASTATIC DISEASE IN A PATIENT WITH AN OCCULT HISTORY OF BREAST CARCINOMA

Abstract

Metastatic disease to the oral cavity is relatively rare and constitutes approximately 1% of all oral cavity malignancies. Skeletal involvement predominates over soft tissue presentations and the posterior region of the mandible is frequently affected. Pain, swelling and sensory alterations have been reported and may mimic periodontal or periapical disease or osteomyelitis. We present a case of a 63-year-old female with a complaint of progressive dysthesia for three months. Panoral and 3D imaging revealed widening of the PDL and loss of lamina dura affecting most of the mandibular teeth, which all tested vital. The patient's medical history was significant for osteoporosis, but there was no history of anti-resorptive drug use. Upon examination, a gingival alveolar swelling was noted. Biopsy revealed high-grade adenocarcinoma, with immunohistochemical features most consistent with a breast primary. Subsequently, it was learned that the patient had a history of breast cancer, treated by total mastectomy of the left breast over three years previously with no previous evidence of metastases. The rarity of metastatic lesions to the jaw makes diagnosis particularly challenging. This case emphasizes the importance of assembling a thorough medical history as part of a complete patient work-up, especially in the presence of atypical symptoms or radiographic findings