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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Oral and maxillofacial pain as the first sign of metastasis of an occult primary tumour: A fifteen-year retrospective study
Shan Shan, Shu Liu, Zhen-Yu Yang, Tie-Mei Wang, Zi-Tong Lin, Ying-Lian Feng, Seyiti Pakezhati, Xiao-Feng Huang, Lei Zhang, Guo-Wen Sun
Shan Shan, Shu Liu, Zhen-Yu Yang, Tie-Mei Wang, Zi-Tong Lin, Ying-Lian Feng, Seyiti Pakezhati, Department of Dentomaxillofacial Radiology, The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
Xiao-Feng Huang, Lei Zhang, Department of Oral Pathology,The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
Guo-Wen Sun, Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
Author contributions: Wang TM contributed to the conception of the work, manuscript editing and integrity of any part of the work; Shan S designed the research study and wrote the manuscript; Liu S, Yang ZY, Lin ZT and Feng YL performed the research; Pakezhati S, Huang XF, Zhang L and Sun GW analyzed the data; all authors have read and approve the final manuscript.
Supported by the Jiangsu Province Natural Science Foundation of China, No. BK20150089; and the Nanjing Science and Technology Development Fund, No. 201503038.
Institutional review board statement: This study was reviewed and approved by the Nanjing Stomatological Hospital Medical School of Nanjing University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Tie-Mei Wang, PhD, Chief Physician, Department of Dentomaxillofacial Radiology, The Affiliated Stomatology Hospital of Medical School, Nanjing University, No. 30 Zhongyang Road, Nanjing 210008, Jiangsu Province, China. tiemei106@126.com
Received: November 16, 2021
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
BACKGROUND
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.
AIM
To explore the clinical and computerized tomography (CT) features of MAJ with oral and maxillofacial pain as the first symptom.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
