Oral metastasis intraosseous mimicking periapical lesion: a case report

Abstract

Jaw metastasis can be mistaken for inflammatory or infectious diseases. Then, they should be considered in the differential diagnosis of unknown jaw lesions. Study reported here involved metastasis of breast cancer in the mandible of a 45-year-old woman. The most important differential diagnostic was a reactive lesion in an unusual periapical location associated with a nonvital tooth. However, given patient’s medical history and because paresthesia and pain were observed a few days after pulpectomy, metastasis of breast cancer could not be ruled out. When bone scintigraphy suggested the metastasis of a malignant bone tumor, incisional biopsy was performed. Histopathologic examination and immunohistochemical reaction confirmed the diagnosis of metastasis of breastcancer, and chemotherapy was thus performed as well. Unfortunately, patient died 2 years after diagnosis. Dentists as well as general physicians should therefore consider presence of oral metastasis in cases involving atypical symptoms, especially in patients with known malignant disease.

Differential Diagnosis of Oral Metastases

“…It is necessary to realize the need to perform biopsy and subsequent microscopic investigation. Metastatic lesions, however, are poorly known, their clinical-radiographic picture is variable, and common inflammatory and reactive lesions can be mimicked (Kumar & Manjunatha, 2013;Allon et al, 2014;Hirshberg et al, 2014;Melgaço-Costa et al, 2020). Some of them are treated based on clinical judgment and the suspicion of a mistake only arises when the therapeutic response does not come.…”