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Metastatic breast carcinoma in the mandible presenting as a periodontal abscess: a case report

Poulias E, Melakopoulos I, Tosios K - J Med Case Rep (2011)

Bottom Line: There were no significant radiographic findings other than alveolar bone loss due to her periodontal disease.The area was biopsied, and histological analysis confirmed the final diagnosis of metastatic breast carcinoma.Paresthesias of the lower lip and the chin should be considered ominous signs of metastatic disease.

Affiliation: Department of Periodontics, University of Louisville School of Dentistry, Louisville, KY, USA. epoulias@yahoo.gr.

ABSTRACT

Introduction: Tumors can metastasize to the oral cavity and affect the jaws, soft tissue and salivary glands. Oral cavity metastases are considered rare and represent approximately 1% of all oral malignancies. Because of their rarity and atypical clinical and radiographic appearance, metastatic lesions are considered a diagnostic challenge. The purpose of this report is to present a rare case of a metastatic breast carcinoma mimicking a periodontal abscess in the mandible.

Case presentation: A 55-year-old Caucasian woman was referred to our clinic for evaluation of bisphosphonate-induced jaw osteonecrosis. She had undergone modified radical mastectomy with axillary lymph node dissection for invasive ductal carcinoma of the left breast. Her clinical examination showed diffuse swelling and a periodontal pocket of 6 mm exhibiting suppuration in the posterior right mandible. Moreover, paresthesia of the lower right lip and chin was noted. There were no significant radiographic findings other than alveolar bone loss due to her periodontal disease. Although the lesion resembled a periodontal abscess, metastatic carcinoma of the breast was suspected on the basis of the patient's medical history. The area was biopsied, and histological analysis confirmed the final diagnosis of metastatic breast carcinoma.

Conclusion: The general dentist or dental specialist should maintain a high level of suspicion while evaluating patients with a history of cancer. Paresthesias of the lower lip and the chin should be considered ominous signs of metastatic disease. This case highlights the importance of the value of a detailed medical history and thorough clinical examination for the early detection of metastatic tumors in the oral cavity.

Panoramic radiograph showing generalized bone loss throughout the dentition.
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Figure 2: Panoramic radiograph showing generalized bone loss throughout the dentition.

Mentions: A panoramic radiograph showed generalized horizontal bone loss throughout the patient's dentition (Figure 2). A peri-apical radiograph of the involved area revealed alveolar bone loss attributable to the periodontal disease. Axial and serial cross-sectional 1 mm-thick cone beam computed tomography (CBCT) showed small radiolucent areas in close proximity to the third molar (Figures 3 and 4) that were not diagnostic of metastases.

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Metastatic breast carcinoma in the mandible presenting as a periodontal abscess: a case report

Poulias E, Melakopoulos I, Tosios K - J Med Case Rep (2011)

Panoramic radiograph showing generalized bone loss throughout the dentition.
© Copyright Policy - open-access
Figure 2: Panoramic radiograph showing generalized bone loss throughout the dentition.
Mentions: A panoramic radiograph showed generalized horizontal bone loss throughout the patient's dentition (Figure 2). A peri-apical radiograph of the involved area revealed alveolar bone loss attributable to the periodontal disease. Axial and serial cross-sectional 1 mm-thick cone beam computed tomography (CBCT) showed small radiolucent areas in close proximity to the third molar (Figures 3 and 4) that were not diagnostic of metastases.

Bottom Line: There were no significant radiographic findings other than alveolar bone loss due to her periodontal disease.The area was biopsied, and histological analysis confirmed the final diagnosis of metastatic breast carcinoma.Paresthesias of the lower lip and the chin should be considered ominous signs of metastatic disease.

Affiliation: Department of Periodontics, University of Louisville School of Dentistry, Louisville, KY, USA. epoulias@yahoo.gr.

ABSTRACT

Introduction: Tumors can metastasize to the oral cavity and affect the jaws, soft tissue and salivary glands. Oral cavity metastases are considered rare and represent approximately 1% of all oral malignancies. Because of their rarity and atypical clinical and radiographic appearance, metastatic lesions are considered a diagnostic challenge. The purpose of this report is to present a rare case of a metastatic breast carcinoma mimicking a periodontal abscess in the mandible.

Case presentation: A 55-year-old Caucasian woman was referred to our clinic for evaluation of bisphosphonate-induced jaw osteonecrosis. She had undergone modified radical mastectomy with axillary lymph node dissection for invasive ductal carcinoma of the left breast. Her clinical examination showed diffuse swelling and a periodontal pocket of 6 mm exhibiting suppuration in the posterior right mandible. Moreover, paresthesia of the lower right lip and chin was noted. There were no significant radiographic findings other than alveolar bone loss due to her periodontal disease. Although the lesion resembled a periodontal abscess, metastatic carcinoma of the breast was suspected on the basis of the patient's medical history. The area was biopsied, and histological analysis confirmed the final diagnosis of metastatic breast carcinoma.

Conclusion: The general dentist or dental specialist should maintain a high level of suspicion while evaluating patients with a history of cancer. Paresthesias of the lower lip and the chin should be considered ominous signs of metastatic disease. This case highlights the importance of the value of a detailed medical history and thorough clinical examination for the early detection of metastatic tumors in the oral cavity.

View Similar Images In: Results  - Collection
View Article: MedlinePlus - PubMed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3151228&rFormat=json&query=null&req=5