Published online May 16, 2022. doi: 10.12998/wjcc.v10.i14.4436
Peer-review started: November 16, 2021
First decision: December 27, 2021
Revised: January 5, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: May 16, 2022
Processing time: 177 Days and 19.5 Hours
Metastatic adenocarcinoma of the jaw (MAJ) is a rare disease that accounts for 1%-3% of all oral and maxillofacial malignant tumours. Oral and maxillofacial pain may be the first symptom of metastatic spread of an occult primary tumour. Therefore, early identification of oral and maxillofacial pain by dental professionals is critical.
To explore the clinical and computerized tomography (CT) features of MAJ with oral and maxillofacial pain as the first symptom.
The medical records of all patients who were treated in our hospital between January 2006 and February 2020, and diagnosed with MAJ with oral and maxillofacial pain as the first symptom, were reviewed retrospectively. Clinical data were collected on age, sex, medical history, clinical manifestations, site of metastasis, and site of the primary lesion. CT features were analysed in detail, and a radiological classification scheme comprising five types: Osteolytic, osteoblastic, mixed, cystic, and alveolar bone resorption was proposed.
The primary sites of MAJ were the lungs (n = 6), liver (n = 4), kidneys (n = 2), prostate (n = 1), and gastric cardia (n = 1). Five tumours were classified as the osteolytic type, all with a permeative margin (100%, P < 0.05), and three were classified as the mixed type, mostly with a moth-eaten margin (80%, P < 0.05). The cystic (n = 3) and alveolar bone resorption (n = 1) types had geographic margins, and the osteoblastic type (n = 1) had sclerotic margins. Moreover, nine tumours showed periosteal reaction and five showed a localised soft tissue mass, while the occurrence of jaw expansion was relatively rare.
MAJ has complex clinical and CT features. Oral and maxillofacial pain may be the first sign of a primary tumour affecting other sites.
Core Tip: Metastatic adenocarcinoma of the jaw (MAJ) occurs predominantly in middle-aged and elderly men, most commonly in the posterior mandible. To our knowledge, this study is the first to propose cystic and alveolar bone resorption types based on the structure of the jawbone. MAJ is typified by numb chin syndrome, as well as rapidly progressive osteolytic bone destruction with periosteal reaction and a localised soft tissue mass, usually without jaw expansion on computerized tomography. These features may provide a basis for the clinical diagnosis of MAJ.