Maxillary Metastasis Research Articles

Pentoxifylline and tocopherol as prophylaxis for osteonecrosis of the jaw due to bone-modifying agents in patients with cancer submitted to tooth extraction: a case series.

To assess the prophylaxis effect of pentoxifylline and tocopherol (PENTO) on the frequency and severity of medication-related osteonecrosis of the jaw (MRONJ) diagnosed at three months in patients with cancer submitted to tooth extractions during the treatment with bone-modifying agents. This case series was conducted at the outpatient dental clinic of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between April 2021 and April 2022. Patients ≥ 18years old were included; those with maxillary metastasis or who performed head or neck radiotherapy were excluded. The PENTO protocol was prescribed two weeks before and two weeks after the tooth extraction, and patients were reassessed one week, one month, and three months after the extraction. The main outcome was the development of MRONJ. Of the 114 screened patients, 17 were included; they were aged between 43 and 73years and were mostly female (88.2%). Thirty-two tooth extractions were performed (22 in the maxilla and 10 in the mandible). Breast cancer was the most predominant neoplasm (70.6%), being metastatic in 35.3% of patients. Also, all patients used intravenous bisphosphonates. Stage 1 MRONJ was diagnosed in three patients (17.6%), representing three (9.4%) of all tooth extractions. The repair of MRONJ was achieved 30days after the PENTO protocol. The prophylaxis use of PENTO reduced the severity of injuries, was well-tolerated, and showed patient compliance.

Papillary thyroid carcinoma with maxillary metastasis

Abstract Introduction: The incidence of distant metastasis in papillary thyroid carcinoma (PTC) is less than5%. Most such metastases occur in the lungs and bones. More than 80% of bone metastases are located in the axial skeleton. Metastasis to the facial bones is extremely rare. Patient concerns: A 36-year-old man presented with intermittent attacks of epistaxis, nasal obstruction, right-sided facial swelling, and a progressive headache without fever or preceding dental trauma. He had undergone total thyroidectomy with neck dissection for PTC in 2017. Diagnosis: Computed axial tomography and magnetic resonance imaging of the head and neck region showed a well-defined mass occupying the right maxillary sinus with bony erosion, measuring approximately 5.8 × 3.2 × 5.3 cm. Biopsy revealed metastatic PTC, which was confirmed using immunohistochemistry. Interventions: The patient underwent debulking surgery in the form of partial maxillectomy and reconstruction of the mucosal defect using a buccal pad of fat. A post operative therapeutic dose of radioactive iodine (TDRI) was administered. Outcomes: A whole-body iodine scan performed 5 days after the dose revealed multiple metastases affecting the right maxilla, both lungs, and left tibia. The patient was discharged on the fifth day following TDRI and resumed thyroid suppressive therapy. The patient was scheduled for another TDRI six months later. Conclusion: Maxilla metastasis of PTC is rare, usually occurs in women, and is usually associated with other metastases. When maxillary bone metastasis occurs, physicians, dentists, and pathologists should not exclude the possibility of metastatic PTC.

Maxillary sinus metastasis in breast cancer; a case report and review of the literature

Paranasal sinuses are an infrequent site for tumor metastasis, and breast cancer metastasis to these sinuses is very rare. To date, less than 20 cases of breast cancer metastasis to paranasal sinuses have been reported. This case study’s purpose was to describe a 69-year-old woman with a history of breast cancer treated 15 years ago who developed the symptoms of rhinosinusitis. Physical examination showed exophthalmos and maxillary sinus tenderness. Finally, breast cancer metastasis to paranasal sinuses was diagnosed using CT scan. She received hormone therapy, systemic chemotherapy, and maxillary sinus radiotherapy. The treatment was well tolerated, and lesions observed in CT scan improved and after more than a year the patient is still alive.

A rare case: a lung cancer with maxillary metastasis

A rare case: a lung cancer with maxillary metastasis

Oral and Maxillary Metastases: Retrospective Clinical Analysis of 21 Cases

espanolObjetivo: Estudio descriptivo retrospectivo de 21 casos de metastasis en tejidos blandos orales y/o huesos maxilares. Material y metodos: Revision a 12 anos de actas de nuestro departamento, excluyendo procesos linfoproliferativos, metastasis cutaneas, glandulas salivales, otros huesos craneofaciales y ganglios cervicales. Se recopilan datos epidemiologicos, antecedentes, clinicos, tratamiento y seguimiento, y analizan mediante estadisticos de frecuencia. Resultados: La proporcion varon:mujer es 1,3:1, entre 52-82 anos y todos de etnia blanco-caucasica. El 19,0 % tiene exposicion laboral carcinogena, el 52,4 % tabaquismo, el 61,9 % consumo de alcohol, el 57,1 % riesgo cardiovascular, el 19,0 % patologia cardiaca, el 28,6 % pulmonar, el 19 % gastrointestinal, el 19 % endocrina, el 14,3 % genitourinaria, el 9,5 % otro tumor maligno primario y el 23,8 % un familiar de primer grado con una neoplasia, el 33,3 % ha tomado farmacos asociados a osteonecrosis o recibido radioterapia craneofacial. Siete pacientes debutan con la metastasis y 14 como progresion de neoplasia conocida. El motivo de consulta principal es una masa. Ocho lesiones afectan a tejidos blandos y 13 al hueso. El 81 % son tumores de estirpe epitelial. El origen es: 23,8 % pulmon, 23,8 % mama, 23,8 % renal, 9,5 % piel, 9,5 % partes blandas, 4,8 % prostata y 4,8 % tiroides. El 100 % tiene metastasis en otras localizaciones. El 14,3% pacientes son tratados con cirugia, el 38,1 % con radioterapia, el 47,6 % con quimio- o terapia dirigida, y el 28,6 % con tratamiento sintomatico. 17 pacientes fallecidos y 4 vivos con rango 1-124 meses de seguimiento. Conclusiones: Las metastasis craneomaxilofaciales, habitualmente con multiples lesiones viscerales o en esqueleto axial, tienen pronostico infausto. El manejo multidisciplinar podria beneficiar el estado basal del paciente y llevar a mejores resultados. Existen casos excepcionales de supervivencia a largo plazo. EnglishObjective: Retrospective descriptive study of 21 oral soft tissue and/or maxillary bone metastatic cases. Materials and methods: Hospital records of our own department are reviewed for a 12-year period. Lymphoproliferative diseases, skin metastases, salivary glands, other craniofacial bones and cervical lymph-nodes are excluded. Epidemiologic, personal health, clinical, treatment and follow-up data are recollected and analysed in frequency statistics. Results: Male:Female ratio is 1.3:1, year-old range 52-82 and ethnic group 100 % white-caucasian. 19.0 % have carcinogenic occupational exposure, 52.4 % tobacco abuse, 61.9 % some kind of alcohol use, 57.1 % cardiovascular risk, 19.0 % cardiologic records, 28.6 % pulmonary, 19.0 % gastrointestinal, 19.0 % endocrine, 14.3 % genitourinary, 9.5 % other primary malignancy and 23.8% a first-degree relative with a neoplasm. 33.3 % patients have taken osteonecrosis-related drugs or received craniofacial radiotherapy. Metastasis is the debut in 7 patients while it corresponds to infirmity progression in 14. The chief reason for consultation is a mass. 8 lesions affect soft tissue and 13 the bone. 81.0 % have epithelial neoplasm lineages. The organ of origin is: 23.8 % lung, 23.8 breast, 23.8 % kidney, 9.5 % skin, 9.5 % soft parts, 4.8 % prostate and 4.8 % thyroid. 100 % have other location metastases. 14.3 % patients undergo surgery, 38.1 % receive radiotherapy, 47.6 % chemo- or targeted therapy, and 28.6 % symptomatic treatment. After a 1-124 months range of follow-up, 17 patients die and 4 are alive. Conclusions: Craniomaxillofacial metastases, usually with multiple visceral or axial skeleton lesions, have an ominous prognosis. Multidisciplinary management could benefit the patient status and lead to more favourable outcomes. There are exceptional cases of long-term survival.

Bronchogenic adenocarcinoma metastatic tumor mimicking a dentoalveolar abscess in the maxilla.

Intraosseous metastatic tumors (IOM) in maxilla are less frequent than the soft tissue metastatic tumors. Lung and bronchogenic metastatic tumors are uncommon in the maxilla. We present a maxillary bronchogenic metastasis with a rare clinical appearance. IOM was misdiagnosed as a dentoalveolar abscess and treated with antibiotics for 3 weeks. After not responding to antibiotics, the patient's general dental practitioner forwarded the patient to the Department of Oral and Maxillofacial Surgery. The associated tooth was extracted and the patient was recalled 1 week later. No signs of improvement were observed, and cytology, biopsy, and radiology diagnostics were performed. Cytologic results and biopsy could not differentiate a metastatic tumor from a salivary duct carcinoma. Ultimately, negative androgen receptors immunohistochemistry supported the diagnosis of bronchogenic metastatic adenocarcinoma. This case report stresses the importance of taking a thorough medical history. To our knowledge, this is the third bronchogenic IOM to the maxilla reported, mimicking a dentoalveolar abscess. General dental practitioners are among the first in contact with oral metastatic tumors and it is therefore important to report unusual clinical cases, as they present a diagnostic challenge for both the clinician and the pathologist.

口腔に初発症状を認めた肺原発上顎歯肉転移癌の1例

今回われわれは，上顎歯肉に初発症状を認めた肺原発上顎歯肉転移癌を経験したためその治療経過の概要に文献的考察を加えて報告する。患者は80歳男性，初診時右側上顎歯肉に，直径18mm弾性軟の腫瘤を認めた。生検の結果，大細胞癌と診断された。歯肉原発の可能性が低く，全身精査を実施したところ，左側上肺野，胃，脳に腫瘍性病変を認め，肺原発多発転移癌の診断を得た。上顎歯肉転移癌は生検後急速に増大したため，S-1を併用した同時化学放射線療法を実施し，照射量合計38.4Gyで終了した。これらの放射線治療によって上顎歯肉転移癌の縮小を認めた。治療後，脳梗塞を発症し死の転帰となったが，死の直前まで腫瘍の増大もなく，経口摂取の継続が可能であった。根治治療の適応がない肺原発歯肉転移癌に対する，姑息的同時化学放射線療法は，患者のQOL維持に有効な治療法の1つであると思われた。

Inflammatory Myofibroblastic Tumor of the Lung and the Maxillary Region: A Benign Lesion with Aggressive Behavior

Inflammatory myofibroblastic tumor (IMT) is a rare mass-forming lesion characterized by fibroblastic or myofibroblastic spindle cell proliferation with varying degrees of inflammatory cell infiltration. Although it has been reported in virtually every organ in the body, the lung is the most common site of involvement. Extrapulmonary IMTs, although rare, have been reported and are characterized by different, more aggressive behavior. We report an extremely rare case of maxillary metastases of pulmonary IMT. Lung IMT was initially misdiagnosed, and oral lesion mimicked clinically and radiologically a radicular cyst. On histologic examination, cells exhibited diffuse and intense immunoreactivity for α-smooth muscle actin and vimentin whereas both pulmonary and oral IMTs presented absence of cellular atypia and lack of expressivity of oncogenic determinants. Distant metastases of lung IMT are extremely unusual, and this is the first report to our knowledge with this particular clinical course. Despite the possibility that the present case could also represent a metachronous multifocal IMT, with pulmonary and extrapulmonary lesions, similar histopathological and immunohistochemical patterns in lung and maxillary region suggest a metastatic course.

Maxillary Metastasis of a Medullary Thyroid Carcinoma in a 21-year-old Woman 7 Years After Thyroidectomy

A healthy, 1-month postpartum 21-year-old woman com-plained of an expansile, painless swelling in the anterior leftmaxilla, which had progressed in size over the last 2months. The patient also complained of back pain, sweat-ing, chills, dysphagia, and loss of appetite during the pre-ceding 2 weeks. She had undergone vaginal delivery 3weeks previously. Her past medical history was significantfor thyroidectomy 7 years before at age 15, for what she

Treatment of metastatic sarcomatoid carcinoma with doxorubicin and ifosfamide

21518 Background: Sarcomatoid carcinoma is a rare, aggressive malignancy containing both mesenchymal and epithelial components. Patients often present with advanced disease and survival is poor. The effectiveness of chemotherapy is unclear. This study aims to determine short-term outcomes using doxorubicin and ifosfamide for treatment of metastatic sarcomatoid carcinoma. Methods: Pathology records were searched for all patients with sarcomatoid carcinoma treated in our clinic with doxorubicin and ifosfamide. Outcome measures were chemotherapy response and survival. Results: Of 15 identified patients, 4 met inclusion criteria. Mean age at presentation was 62 (range 48–72). All patients had high grade tumors and metastatic disease at presentation. Patient 1 (breast) had prior resection and radiation for the breast tumor, and at presentation had metastatic disease to the lungs. She had a slight increase in size of the lung metastases with chemotherapy, but resection showed 99% necrosis. She had no evidence of disease for 14 months. The tumor then recurred in the lungs and progressed despite further chemotherapy. She died of disease 48 months from diagnosis. Patient 2 (humerus) had a decrease in size of the humerus tumor and stability of the lung metastases with pre-operative chemotherapy. Following shoulder disarticulation, he had no remaining local disease, but the lung metastases progressed despite additional chemotherapy. He died of disease 16 months from diagnosis. Patient 3 (pleura/pericardium) had a decrease in size of the pericardial disease but developed new lung tumors following chemotherapy. He died of disease 7 months after diagnosis. Patient 4 (supraclavicular area) had an initial response to chemotherapy with near complete necrosis of the supraclavicular tumor and 75% decrease in size of a maxillary metastasis, but he developed brain metastases within 2 months. The patient died of disease 9 months from diagnosis. Mean overall survival was 20 months (7–48) with 100% mortality at last follow-up. Conclusions: Half of our patients with metastatic sarcomatoid carcinoma experienced an initial response to chemotherapy with doxorubicin and ifosfamide. However, all patients ultimately progressed and died of disease despite continued treatment. No significant financial relationships to disclose.

Maxillary mass as the presenting manifestation of papillary thyroid carcinoma

A case of follicular variant of papillary thyroid carcinoma presenting with a right maxillary mass is described. This is perhaps the first instance of maxillary metastasis from papillary thyroid carcinoma.

Mandibular metastasis of bladder transitional cell carcinoma

Metastases to the oral cavity account for 1% to 8% of all malignant tumors of the mouth.1 In this context, maxillary metastases are rare,2 and usually involve dissemination from the breast, lung, kidney, thyroid, prostate, gastrointestinal tract, liver, testicle, uterus, and ovary.1,3 Bladder carcinoma only rarely gives rise to oral metastasis.4-5 The following is the case of a patient who developed mandibular metastasis 2 years after surgery for a papillary transitional cell bladder carcinoma.

Nasopharyngeal Melanotic Melanoma

This report presents a rare case of nasopharyngeal melanoma with maxillary sinus extension and lymph node metastasis. The unusual magnetic resonance signal features and the differential diagnosis are discussed.

Mandibular metastasis from a cerebellar medulloblastoma

Metastasis of cerebellar medulloblastoma frequently involves bone.1,2 Smith et al’ report that among eight cases of metastatic medulloblastoma one was mandibular and histologically verifiable. No case of metastasis to the mandible is included in the reports of Cash et al3 and McDaniel et a1.4 Booher et al,’ investigating 43 cases of bone metastasis, noted that the metastases were multiple and affected the pelvis, vertebra, and ribs (this study described a case of mandibular metastasis in a 6year-old boy and cited the previous case by Smith et al’). Black and Keats6 reported a maxillary metastasis in a 3-year-old boy. These reports do not include radiographic or histologic findings, and detailed description of the oral symptoms are lacking. Eversole et al’ reported on an 11-year-old girl in whom metastasis occurred in the mandible 18 months following surgery and radiation of a primary cerebellar tumor. The lesion had a radiolucent radiographic image. van der Kwast and Waal’ reported on an &year-old girl with confirmed jaw metastasis by postmortem intraoral biopsy. Neither study mentions a glioma stage. This is the first case report describing signs of intraoral metastasis of a medulloblastoma, with improvement attained by chemotherapy. The findings are supported by radiographs, intraoral photographs, and compatible histologic images of the primary and metastatic lesions.

上顎に転移した肝細胞癌の１例と文献的考察

A case of maxillary metastasis from abdominal hepatocellular carcinoma, occurred in a 59-year-old male, is reported in this paper with literature review. In this case, a maxillary gingival mass with occasional bleeding was his chief complaint at reference from his dentist. Biopsy was carried out and the histology revealed maxillary metastasis of the hepatocellular carcinoma. Later, sarcomatous change of the tumor was detected in the specimens taken from the primary site and the metastatic lesions in other parts of the body.

Maxillary metastasis of transitional cell carcinoma: Report of a case

Metastases to the maxilla are extremely rare, and only 64 cases of histologically proven maxillary metastases can be found in the English-language literature. This article reports the first case of metastatic transitional cell carcinoma of the urinary bladder to the maxilla. The distribution of proven cases of maxillary metastasis and the possible anatomic pathways for this metastasis are discussed.

下がく骨へ転移をきたしたじんがんの１症例と文献的考察

Although bone metastasis of a malignant tumor is not rare, it is generally thought that intraoral maxillary metastasis from other organs is rare.The authors experienced a case of mandibular metastasis of the renal cancer, on which a report is made here with literature consideration thereof.Patient: S.S. 49-year-old man (office man)Initial medical examination: November 24, 1981Chief complaint: Formation of a painless tumor at his left mandibular mental foramen regionFamily history: Pneumonia (20 years ago) and sciatica (12 years ago)Present illness: About a month ago, a thumb-sized swelling was noticed at his left cheek, and he consulted a town doctor for lower lip paresthesia. Chemotherapy was performed for 10 days without symptomatic improvement and he came to our Department of Oral Surgery.Present examination: The patient had moderate general physique and eutrophia. His countenance was nearly symmetrical, however, a thumb-sized elastic and hard tumor was palpable at his left mental foramen region. On the affected side intraorally, there observed a defect of the mandibular molar and a tumor at the dental root of the mandibular premolar. There was neither gingival inflammation nor swelling of its attached submandibular lymph node.Results of clinical examinations: X-ray exploration revealed a thumb-sized and comparatively well-defined bone resorption shadow, centering around his left mental foramen region. There were no abnormal values obtained from general blood examinations.Treatment: The tumor suspected of mandibular cyst was extirpated under general anesthesia.Results of histopathological examination: The extirpated multinodular solid tumor, covered with connective tissues, was diagnosed pathologically as a clear cell carcinoma with a honeycomb-like structure which was delimited by the abundant strome and blood vessels.Postoperatively, the intraoral wound showed good healing, process however, the lung or kidney was suspected as the primary site of this tumor, and a co-exploration by the Department of Surgery and the Department of Urology and a detailed examination detected left renal cancer of the patient who was then transferred to be radically operated for renal cancer.Literature examination of such cases revealed that intraoral bone metastasis of renal cancer was rare. The treatment of intraoral metastatic cancer is usually perfomed at its relatively early phase and its prognosis was frequency poor depending on the result of the treatment for its primary focus.

Metastatic malignancy of the jaws

Metastatic malignancy from a distant primary site involving the jaws, although rare, is worthy of special attention. If for no other reason, metastatic malignancy involving the jaws should be emphasized as a possibility in the diagnosis of jaw neoplasms in order to spare a significant number of patients with occult malignancy the tragedy of useless disfiguring radical surgery. Based on mathematical probabilities it is likely that at least 100 instances of jaw metastasis from distant occult carcinomas could be seen in this country every year. Indeed, with increasing awareness of the possibility, the number of cases reported is growing. In this article jaw metastasis is sharply distinguished from invasion of the mandible by oral malignancy which occurs with relatively great frequency. The authors are not convinced that other workers describing and reporting metastasis to the jaws from primary intraoral carcinoma have critically differentiated between direct invasion and metastasis. In some cases jaw metastasis may be the first and only symptom of malignant disease which is growing silently elsewhere in the body. Usually, however, if the mandible is involved, there is detectable metastatic disease elsewhere. The possibility of multiple primary carcinomas with one involving the jaw should always be considered. Obviously the prognosis in this type of case could be better than the case in which the oral lesion is metastatic from a distant primary. In the first instance each case of malignancy occurring at the same time in the same patient would have to be evaluated on its individual merits. In the latter case the patient has widely disseminated metastasis and is in a hopeless state. A review of the literature from 1902 to 1953 revealed a total of 176 cases of metastatic malignancy involving the jaws. The primary lesions most frequently accounting for jaw metastasis were carcinoma of the thyroid, hypernephroma, carcinoma of the breast, carcinoma of the lung and carcinoma of the prostate. Metastatic lesions have also been reported from carcinoma originating in the following organs: stomach, large intestine, rectum, parotid gland, tonsil, adrenal gland, ovary, testes, lip and nasal mucous membrane; sarcoma of the ovary, breast and bone; lymphosarcoma, Kaposi's sarcoma and malignant melanoma. The pathologic features are essentially those found in metastatic malignancy involving osseous structures elsewhere. Osteoclastic or osteoblastic lesions may be found, although the majority of reported lesions were osteoclastic. The mental nerve and the teeth may be involved. The symptomatology included paresthesia, numbness and swelling of the lip, pain and tenderness in the involved area, “toothache,” external tumor mass, soft tissue mass and loosening of the teeth. A complete and accurate history of present symptoms, history of past illnesses, systemic review and complete physical examination are essential to correct diagnosis. Perhaps the most essential point in the diagnosis is to think of the possibility. Roentgenographically, metastatic malignancy may be confused with primary oral malignancy, primary mandibular malignant tumors, benign tumors, cysts and infections of dental origin. Occasionally symptoms may be present in patients with known malignancy and yet roentgenograms of the jaw are normal. Adequate biopsy is essential for accurate diagnosis and should be interpreted by a competent tumor pathologist. Treatment should consist only of palliative roentgen therapy to reduce the size of the lesion and relieve pain. Seven new cases of metastatic malignancy involving the jaws are reported. These lesions originated in the following sites: three cases of carcinoma of the breast, one case of carcinoma of the lung, one case of seminoma of the testis, one case of carcinoma of the rectum and one case of lymphosarcoma. The first known case of seminoma of the testis with mandibular and maxillary metastases as the presenting symptoms is reported.