Mandibular Metastasis of Silent Papillary Thyroid Carcinoma: A Rare Case Report with Review of the Literature

Abstract

Metastasis to the jaws is a rare event; however, it has great importance because it may be the only symptom of an undiagnosed underlying malignancy. Papillary thyroid carcinoma, the commonest histopathologic variant of thyroid cancer, has minimal potential for distant metastasis, and most reported metastatic thyroid carcinomas of the oral cavity have been follicular thyroid carcinoma. The aim of this article is to present a rare case of metastatic papillary thyroid carcinoma, which presented itself as a painless expansion in the anterior region of the mandible in a 56-year-old female, and to review previously published cases of this type of cancer. Reporting rare cases such as this one, together with reviewing previous reports of related rare diseases, will expand the body of knowledge about these uncommon lesions.

Oral metastasis as the first indication of undiscovered malignancy at a distant site: A systematic review of 413 cases

“…In contrast, females seemed to be more likely to be affected by thyroid tumors (81.3%) than males, as also reported 28 . This high tendency toward females is associated with the high incidence of thyroid carcinoma in women 23 …”

“…In fact, cells of these primary sites tend to have pulmonary tropism 18–22 . On the other hand, thyroid cells seem to prefer the lymphatic pathway to reach the mouth 23 . Similarly, liver cells can use Batson's plexus for this purpose.…”

“…In both cases, they would not pass through the lung, delaying the generalization of spread 18 . In addition, thyroid tumors tend to have a relatively indolent biological behavior; and oral lesions arising from liver tumors are quite bleeding, attracting attention 23–26 . These factors would increase the chances of oral metastatic lesions of both sites (thyroid and liver) being single foci of dissemination, at the time of diagnosis.…”

Papillary thyroid carcinoma with maxillary metastasis

“…A search through PubMed from 1990 to 2021 using the search terms "papillary thyroid carcinoma +oral metastasis" without using software filters revealed 125 publications among which,7 publications matched our topic. [7][8][9][10][11][12][13] While searching for the search terms "papillary thyroid carcinoma +maxillary metastasis" within the same period, three publications were retrieved. [10,14,15] Papillary and follicular thyroid carcinoma (FTC) account for 80% and 7% of all thyroid carcinomas, respectively.…”

Subcutaneous Recurrences of Thyroid Cancer After Conventional Transcervical Thyroidectomy: A Case Report

“…Therefore, to control the contamination of benign tissue by viable malignant cells during surgery, the surgeon should adhere to the tumor-free principle during operation and should consider the risk of implantation metastasis following the surgery. Besides, subcutaneous metastases may be variable and typically asymptomatic in clinical presentation and are always discovered incidentally (16). Clinicopathology and immunohistochemistry, especially for poorly differentiated tumors, play an important role in the identification of suspicious skin lesions.…”