Metastatic follicular thyroid carcinoma to the mandible: A case report and review of the literature

Abstract

(Editorial Comment: The reporters document an unusual site for metastatic thyroid cancer. Comprehensive surgical intervention resulted in a good initial outcome.) A 64-year-old white woman was referred to our clinic with a 1.5 year history of a progressively enlarging mass in the right preauricular region. She also had a history of a large goiter of 15 years’ duration. Other medical problems included uncontrolled diabetes mellitus and ischemic heart disease. Physical examination revealed a 10 X 10 cm firm, tender, pulsatile mass in the right preauricular and cheek regions. A significant bruit over the mass was heard on auscultation. The thyroid gland was markedly enlarged, with a 6 X 8 cm mass originating from the right lobe. There were no palpable lymph nodes in the neck. Examination of the oral cavity revealed medial displacement of the right buccal mucosa, with significant mucosal irregularities along the dental occlusion line, suggesting mucosal biting. The patient had mild trismus. The rest of the otolaryngological examination, including the cranial nerves, was normal. Radiographic studies including computer tomographic (CT) scans and magnetic resonance images (MRI) of the head and neck showed an extremely vascular infratemporal fossa mass. The mass was medial to the parotid gland and replaced the mandible from the condyle to the posterior third of the body on the right side (Figs 1 and 2). Fine needle aspiration biopsy (FNAB) of the mandibular mass was consistent with a carcinoma, but the histological subtype could not be further classified based on the cytological findings alone. FNAB of the thyroid mass showed a benign thyroid nodule. A metastatic work-up including brain, chest, abdomen, and pelvis CT scan was normal. Whole body skeletal survey by bone scintigraphy was normal, with the exception of the mandibular involvement on the right side. Because of the seemingly high vascular