Incidence and clinical consequences of distant metastases in the area of the jaw/face]

Metastases from primary tumours and distant sites to the maxillofacial region are rare. The establishment of an exact diagnosis is often difficult because of the atypical clinical and roentgenological appearances. Thirty-five cases of distant metastases to oral soft tissues and jaws are presented. The most common primary tumours were renal carcinomas followed by breast cancers. In most cases metastatic lesions lie in the distal segment of the mandible. The possibilities of treatment are very limited.     

Metastatic hypernephroma to the head and neck: unusual case reports and review of the literature.

Hypernephroma is one of the most common tumours to spread by extranodal metastases to the head and neck. We herein report on six patients with unusual metastatic hypernephroma to the head and neck area. In two of the six cases, the metastatic tumour in the head and neck was the presenting symptom, and the renal tumour was secondarily detected. Metastatic hypernephroma to the head and neck area has been demonstrated mostly in the paranasal sinuses, parotid gland, and the mandible. Among the six cases presented, four belong to the above-mentioned group, but the other two are rather rare cases, one metastatic to the nasopharynx and soft palate and the other to both lobes of the thyroid gland. Hypernephroma should be sought and excluded whenever a metastatic lesion is encountered in the head and neck area, even if the metastatic lesion is the first clinical presentation. The diagnosis of metastatic hypernephroma should be suspected in any patient with even a remote history of renal cell carcinoma.     

Metastatic prostate carcinoma mimicking a parotid tumor: a case report

We report a case of prostate carcinoma metastatic to the mandible that had been initially suspected as being a primary tumor of the parotid. The initial symptom was hard swelling in the left parotid region. No pathologic fracture was diagnosed. The metastatic lesion was diagnosed 4 years after diagnosis of the carcinoma of the prostate. This is a very interesting event because of its unusual localization.     

Neurofibroma of infratemporal fossa

Neurogenic tumours form a very small percentage of all neoplastic Unions of head and neck region. The histological classifications of benign neurogenic tumours of head and neck include neurofibroma, schwannoma and neuromas. The purpose of this paper is to report a case of neurofibroma involving right infratemporal fossa, pterygopalatine fossa, nasopharynx which was treated surgically through a transmandibular approach. A benign tumour arising in this anatomical position requires a conservative surgical approach for cosmetic reasons, in this case access was provided by mandibular swing, after lateral mandibular osteotomy in front of the angle of mandible. This surgical procedure provided useful access to such a cryptic anatomical region whilst ensuring a satisfactory cosmetic result.     

Marijuana smoking as a possible cause of tongue carcinoma in young patients

A case of T1N0M0 carcinoma of the tongue in a male 23-year-old 'regular' marijuana smoker is described. Hemiglossectomy and complete bilateral neck dissection were carried out. No post-operative radiotherapy was given as the resection margins were histologically negative. The tumour recurred one year later in the left cervical region involving the mandible and surgery was again performed, but after three months, neck disease was still evident. The case described case implies the introduction of marijuana as a possible new risk factor in the development of oral cavity tumours. Resection of the primary lesion has to be as wide as possible even in T1 cases, due to the aggressive biological behaviour of such tumours in young subjects.     

Malignant fibrous histiocytoma of the mandible

Malignant fibrous histiocytoma (MFH) of the mandible is rare. We describe a case of MFH of the mandible with metastatic disease to the lungs. To our knowledge only 30 cases have been reported prior to the present case. In previously reported cases, there was a strong tendency for the posterior portion of the mandible to be affected by MFH; ours is only the second reported case involving the anterior portion of the mandible. We review the diagnosis, pathology, and treatment of this rare malignancy.     

Cystosarcoma phyllodes metastatic to the mandible: report of a rare case and literature review

Cystosarcoma phyllodes is a rare breast tumor with variable malignant potential. Metastasis has been reported in a small percentage of cases. We describe the case of a 52-year-old woman who developed a large facial tumor 1 year after she had undergone a mastectomy for a rapidly enlarging breast neoplasm. The facial lesion was found to be a malignant cystosarcoma phyllodes metastatic to the mandible, and the patient died shortly after diagnosis. To our knowledge, this patient represents only the third reported case of a phyllodes tumor metastatic to the mandible.     

Unusual parotid tumors.

The patient presenting with a mass lesion of the parotid gland is frequently found to have a mixed tumor of salivary tissue origin. However, less common lesions occur in the anatomical region of the parotid gland. These pathological entities deserve consideration in the differential diagnosis. This report presents nine patients with unusual lesions occurring in the parotid region. These regions include cervicofacial actinomycosis, branchial cleft cyst, parapharyngeal tumors, bony lesion of the mandible, non-parotid origin malignant tumor, and metastatic malignant tumors. Each class of lesions demonstrated is also discussed.     

Mandibular resection in cancer of the tongue and/or mouth floor

The role of the lingual periosteum in the spread of tumours is not yet clear. We examined the histological behaviour of 60 cancers of the tongue and floor of the mouth lying close to the mandible. There were no tumour cells in the periosteal lymphatics. This is in accord with clinical experience that tumour invasion of the periosteum is not associated with an increased rate of metastases to the cervical lymph nodes. From our experience, we conclude that (1) a radical resection of the mandible is mandatory for every lesion lying in the gingivo-lingual gutter that invades bone; (2) for tumours close to, but not directly invading the lingual surface of the mandible, marginal resection of the alveolar ridge is appropriate and provides an adequate margin.     

Desmoid tumours of the head and neck: A case report

IntroductionDesmoid tumours of the head and neck, also known as fibromatosis, are rare, locally invasive benign tumours with high recurrence rate, causing considerable morbidity. Complete surgical excision of desmoid tumours is considered to be the only effective treatment.Case reportWe present a case of fibromatosis of the right posterolateral region of the neck in a 56-year-old woman who presented with right neck mass. The patient underwent complete excision of the tumour with no adjuvant therapy. No recurrence or neurological deficit was observed 2 years after surgery.ConclusionAlthough desmoid tumour is a benign neoplasm with no metastatic potential, treatment is challenging due to its aggressive, infiltrative behaviour with a tendency to recur.     

Mental neuropathy and pathologic fracture of the mandible as initial symptoms of metastatic prostate carcinoma]

BACKGROUND: Distant metastases of solid tumors account for about 1% of all malign neoplasms. In about 30% of all patients who present with an oral metastasis, the distant primary tumour has not been diagnosed yet. CASE REPORT: We report the case of a 71-year-old man who clinically demonstrated unilateral mental neuropathy as well as pathologic fracture of the mandible. Prostate carcinoma was identified as a primary tumor. Clinically, there was significant hypesthesia of the skin area innervated by the left inferior alveolar nerve. X-ray examination revealed an osteolytic lesion of the ascending ramus of the mandible as well as a pathologic fracture of the mandible. Further imaging showed an extensive neoplasm of the mandible and adjacent soft tissues and significant supraclavicular lymph node enlargement. The diagnosis of metastatic carcinoma of the prostate was histopathologically confirmed. CONCLUSION: Mental neuropathy without a dental focus indicates screening for an osseous metastasis. In cases of left-sided supraclavicular lymph node enlargement in men over 45 years, metastatic prostate carcinoma must be excluded.     

Plexiform ameloblastoma presenting as a sinonasal tumor

Ameloblastomas are the most frequent odontogenic tumours, accounting for 1% of all tumours of the maxilla and mandible. Sinonasal ameloblastomas are most common between the ages of 55 and 65, and mandibular ameloblastomas between 40 and 50. Incidence is higher in males than in females, and there are no differences between races. These locally aggressive tumours originate in the mandible in 80% of cases and in the maxilla in 15–20%. We report an unusual primary nasosinusal ameloblastoma presented in a 68-year-old male. The tumour was completely resected by (para)lateral rhinotomy and treated with postoperative radiotherapy. Histological analysis demonstrated a plexiform ameloblastoma. The patient remains well without disease after 50 months of postoperative follow-up.     

Synovial sarcoma of the mandible in children. Apropos of a case

Synovialosarcoma is an aggressive malignant soft-tissue tumor. It's a mesenchymal tumor rare in the cephalic region in the children. Its occurs most frequently in the extremities, in the adolescents and young adults between 15 and 40 years. His treatment are principally a radical surgical excision. We report the case of a 10 year old boy who had a mandibular tumor developing in the first premolar area and invading the submandibular region. The histologic diagnosis was biphasic synovialosarcoma with epithelial predominance. The staging showed a stage II tumor (5 cm) of the submandibular region with invading the mouth floor and the mandible. After the failure of the polychemotherapy we had performed a radical surgical excision with a functional cervical lymphadenectomy. The tumor was excised in one piece with the horizontal part of the left hemimandible. The treatment was completed by radiotherapy. In a second time a reconstructive surgery was performed with a fibula free flap. The result at one year show a good local control and a perfect esthetic and functional result of the mandible. CONCLUSION: Synovialosarcoma is a very aggressive malignant soft-tissue tumor with a high metastatic risk. Management must be rapid as soon as the diagnosis is made. Surgical excision is the main treatment in association with the chemotherapy and radiotherapy.     

Evaluation of the primary tumour and the metastatic lymph node with or without extracapsular spread by means of argyrophillic nucleolar regions (AgNOR)

Though TNM staging is the most popular clinical system for defining the prognosis of Head and Neck Squamous Cell Carcinoma (HNSCC), different clinical trials of the tumours with the same TNM stage have caused doubts about this system. Extra Capsular Spread (ECS) in a metastatic lymph node is one of the recently defined prognostic factors in HNSCC. The hypothesis of this study was to assess the relationship between the primary tumour of laryngeal and oral cavity squamous cell carcinoma and the metastatic lymph nodes with and without ECS. The argyrophillic Nucleolar Organiser Regions (AgNOR) count was used as an index of the grade of malignancy of the neoplastic tissue. As a result, significantly higher AgNOR counts were obtained in the metastatic lymph nodes with ECS than in the primary tumours, while the lowest AgNOR counts were found in the metastatic lymph nodes without ECS. However, when primary tumours of the metastatic lymph nodes with ECS and the primary tumours of the metastatic lymph nodes without ECS were compared, no significant difference was found.     

Metastatic disease to the mandible

Metastatic lesions to the mandible are rare, comprising less than 1% of all malignancies. Twenty-two cases of metastatic disease to the mandible were seen from 1938 to 1985. The records of 17 cases were available for detailed review. The age range was from 27 to 80 years with a female to male ratio of 12 to 5. A mandibular or paramandibular mass or swelling was the most common presenting sign. Three patients presented with mandibular metastasis prior to the discovery of the primary tumor. In the other 14 patients, the mandibular lesion appeared from 2 months to 20 years following discovery of the primary tumor. The mandibular lesion was the initial sign of distant metastatic disease in 11 of the 17 patients. Breast, lung, and colon cancer were the most common primary tumors. When presented with an isolated mandibular mass, a high index of suspicion is necessary to make the diagnosis of metastatic disease. Since plain x-rays may initially be normal, technetium or CT scan may be necessary to demonstrate osseous destruction. Inferior alveolar nerve anesthesia should be considered an indication of tumor until proven otherwise. Treatment is often of a palliative nature because of the presence of widespread metastatic disease; however, surgical resection may be considered in the rare patient with a well-documented, solitary mandibular metastasis.     

Germ cell tumor metastatic to the oral cavity

Neoplasms metastatic to the oral cavity are rare, accounting for less than 1% of all malignancies found there. When they do occur, they are usually found in the soft tissue or mandible. Metastatic malignancies involving the gingival, alveolar, or buccal mucosa are very rare. We present a case of what appeared to be a benign epulis in a 25-year-old man. Biopsy revealed that the lesion represented metastatic testicular cancer.     

Mandibular invasion in patients with oral and oropharyngeal squamous carcinoma

Invasion of the mandible in squamous carcinoma of the oral cavity and oropharynx has always proved a problem for head and neck oncologists. We studied 82 patients who had mandibulectomies as part of their primary surgical treatment for cancer of these sites. In 40 patients, the tumour appeared to be invading the mandible on clinical grounds and 33 patients had tumours invading the mandible when the latter was examined histopathologically. Multivariate analysis showed that tumour was more likely to be fixed to and clinically invading the mandible in the presence of cancer of the oral cavity, compared with oropharyngeal cancer (P < 0.0001). There was a high degree of correlation between clinical invasion of the mandible and histopathological invasion of the mandible (P = 0.0059). In addition, clinical invasion of the mandible correlated with radiological findings (P = 0.0284). The 5-year survival of those patients with tumour that appeared not to be invading the mandible was 53% compared with 25% for those where tumour did appear to be invading the mandible (P < 0.02). The sensitivity and specificity of clinical evidence of mandibular invasion was calculated with the final arbiter of invasion being the histopathological findings. The sensitivity of clinical examination was 91% and the specificity 80%. The positive predictive value was 75% and the negative predictive value 93%. Mandibular invasion is a poor prognostic sign in cancer of the oropharynx and oral cavity. Detection of invasion prior to operation is obviously extremely important and it appears that clinical findings are an accurate method of predicting invasion.     

Mandibular mucoepidermoid tumor

One case of mandibular mucoepidermoid tumour was observed in a 57 years old man. A progressive swelling of the mandible was shown with an osteolytic feature on roentgenograms. It was treated by hemimandibulectomy. Grossly, the neoplasm was partly cystic. Histologically, it was mainly composed of intermediate clear cells. Its ultrastructure was quite similar to that of mucoepidermoid tumours in other sites. Heterotopic salivary lobules, though lacking in our case, seem to play the major role in the genesis of these tumours.     

Childhood facial paralysis due to tumours (author's transl)]

Facial nerve palsy due to malignant tumours is uncommon in childhood and adolescence. If present the malignancy may be primary or metastatic, and usually brain tumours, leukaemias, or lymphosarcomas are found. Rhabdomyosarcomas, parotid malignancies, Ewing's sarcomas, Wilms' tumours and neuroblastomas are rare. The nerve lesion may be due to direct tumour infiltration, external pressure on the nerve and secondary ischaemia. In disseminated malignancy the lesion is usually due to extending intraneural infiltration and all parts of the nerve may be affected. If facial nerve palsy coexists the prognosis in childhood malignancies is extremely poor.     

Extramedullary plasmacytoma of the nasopharynx. Typical versus atypical presentation

Extramedullary plasmacytoma are rare plasma cell neoplasias. Eighty percent of these tumours grow in the ENT region. We report a typical case of a woman with a single tumour in the nasopharynx. Actually she is in complete remission after surgical and radiotherapic treatment. We also report an atypical case of a woman with a tumour in the nasopharynx associated with a cervical metastatic adenopathy and a plasmacytoma of bone. The treatment of this widespread disease was systemic chemotherapy. An update on this subject is done.