Mandible-Maxilla
Malignant tumors
Metastases to jaw

Author: Kelly Magliocca, D.D.S., M.P.H., Anthony Martinez, M.D. (see Authors page)

Revised: 25 August 2016, last major update August 2016

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Metastases to jaw

Definition / General
  • Metastases to the jaw and oral cavity are uncommon, ~ 1% of oral malignancies
  • However, up to 25% of oral cavity metastases represent the first manifestation of disease
  • Metastases to the jaw often indicate end stage disease, and are associated with poor survival
Epidemiology
  • Uncommon, ~ 1% of all oral malignancies
  • Most common in 5th to 7th decades; mean age ~ 54 years
  • Common primary sites of origin:
    • Males: lung, kidney, liver, prostate
    • Females: breast, gynecologic, kidney, colorectum

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Distribution of common primary tumors
metastasizing to oral cavity

Sites
  • Jaw bones are more frequently affected than oral soft tissue
    • 2 : 1 ratio
    • Mandible more common than maxilla
  • The gingiva is the most common site of oral soft tissue metastases
Etiology
  • Pathogenesis of oral metastases is not fully understood but current hypotheses include:
    • A multistage process in which cells detach themselves from the primary tumor and are transported by lymphatic or blood vessels
    • In the oral soft tissues, chronically inflamed mucosa, especially gingiva, has a rich capillary network, which can trap the malignant cells and cause metastases
    • Possible role of Batson’s plexus, a valveless vertebral venous network that permits the retrograde movement of tumor cells from lungs towards the face
Clinical Features
  • Variable; symptoms include jaw pain, swelling, paresthesias, toothache, tooth abscess, non-healing tooth infection, tooth exfoliation
  • May present with mental nerve neuropathy, also known as “numb chin syndrome”
    • Characterized by facial numbness along distribution of mental branch of trigeminal nerve
    • Most cases that are not dental in origin are associated with malignant tumors or diffuse metastatic disease
Diagnosis
  • Dependent on clinical, radiologic and pathologic correlation
Radiology Description
  • Varies from well circumscribed to poorly circumscribed radiolucencies
  • Most metastases to jaw tend to be expansile, lytic lesions with ill defined margins and cortical destruction
Radiology Images

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Orthopantogram
(panoramic view)

CT

3D CT



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PET / CT

Prognostic Factors
  • Metastases to the jaw often indicate end stage disease, and are associated with poor survival
Case Reports
Treatment
  • Depending on type of metastasis, treatment includes surgical resection, sometimes combined with radiation therapy or chemotherapy
Clinical Images

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Well defined solitary swelling on right side of mandible

Swelling in lower third of face

Intra-oral view

Micro Images

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Lung metastases

Breast metastasis

Renal cell carcinoma metastasis

Thyroid metastasis

Positive Stains
Differential Diagnosis
  • The differential is broad, mainly based on radiologic findings, and includes:
    • Odontogenic cysts
    • Benign and malignant odontogenic tumors
    • Reactive / inflammatory processes related to odontogenic infection or inflammation
    • Salivary gland neoplasms
    • Other metastases such as lymphoma, melanoma, etc.