Background: Metastatic tumour consists of about 1% of all oral and maxillofacial (OMF) region malignant tumours. Patients usually have a poor prognosis with multi-metastases and leaving no choice than palliation. Here we reported a retrospective study of patients with OMF metastasis in our hospital. Methods: We retrospectively reviewed all patients who had diagnosed an OMF metastasis from the period January 2000 to December 2015 at Guangdong General Hospital. The role of medical imaging in differential diagnosis and some distinct clinical manifestations were further discussed. Results: 12 patients (nine males and three females) were confirmed OMF metastasis. Most common primary site was lung (six cases), followed by thyroid (four cases) and most common involved site was mandible (six cases), followed by parotid (three cases); common symptom were nonspecific, including localised swelling, pain, bleeding and ulceration. Imaging of enhanced computed tomography showed a hypervascular lesion in involved sites in all thyroid metastatic cancers patients. Follow-up varied from one month to 3.5 years and six patients followed-up less than six months died due to multi-metastasis. Patients with the solitary metastases of thyroid cancer had a better prognosis. Conclusions: Clinical and radiographic manifestations of metastases to the OMF region are usually quite variable and nonspecific. Thyroid metastatic tumour often shows a rich vascularity lesion in involved sites and a better prognosis is companied with simultaneous resection of the solitary metastases along with total thyroidectomy followed by radioiodine therapy.
Gastroduodenal artery (GDA) pseudoaneurysm is a rare but potentially fatal complication in chronic pancreatitis. Managing GI bleed in chronic pseudocyst due to ruptured pseudoaneurysm having multiple feeding vessels and that too in a background of portal hypertension is a challenging task. A 43 year old male patient with chronic calcific pancreatitis presented to our department with 10 days history of malena and drop in hemoglobin. He under micro coil embolization of GDA 12 days before in another hospital for ruptured GDA pseudoaneurysm with upper GI bleed. Upper GI endoscopy revealed grade II-III esophageal varices with portal hypertensive gastropathy with blood in 2nd part of duodenum. CECT scan revealed features of chronic calcific pancreatitis with pseudocyst and GDA pseudoaneurysm with intracystic bleed. Patient again underwent coil embolization in our hospital. However, the patient again developed GI bleed. Patient was taken for emergency laparotomy and found to have bleed from splenic artery as well as GDA pseudoaneurysm into the pseudocyst. Transcystic pseudoaneurysm ligation with ligation of intracystic bleeding vessels and lateral pancreaticojejunostomy was done. Postoperatively patient recovered well. Rupture of pseudoaneurysm in chronic pancreatitis is associated with almost 100% mortality if untreated. Though radiological intervention should be the primary modality of treatment, low threshold for surgery should be kept, considering multiple feeding vessels to the pseudocyst pseudoaneurysm, which may be missed in angiography
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