Oral and maxillofacial pain as the first sign of metastasis of an occult primary tumour: A fifteen-year retrospective study

Figure 1 Five types of metastatic adenocarcinoma of the jaw. A: Osteolytic type. Axial spiral-computed tomography (SCT) with bone window showed decreased radiodensity of the lesion (arrow) with a permeative margin. The multi-layered periosteal reaction was observed on the buccal and lingual sides of the left mandibular ramus; B: Osteolytic type. Axial SCT with soft-tissue window showed a confined soft tissue mass (arrow) at the lingual side of the left mandibular ramus; C: Osteoblastic type. Axial SCT with bone window showed increased radiodensity of the lesion (arrow) with a sclerotic margin; D: Mixed type. Oblique sagittal cone beam CT showed both osteolytic and osteoblastic lesions (arrow) with a moth-eaten margin, and an “ivory” pattern of osseous tumour matrix was centred in the left mandibular at the location of mental foramen; E: Cystic type. Partial panorama reconstruction radiograph showed homogeneous radiodensity of the lesion (arrow) in the anterior part of the maxilla with a geographic margin. Teeth displacement and root resorption were observed; F: Alveolar bone resorption type. Axial SCT with bone window showed bone destruction was confined to the alveolar bone with a geographic margin. A soft tissue component was at the buccal side.

Figure 2 Three cases of the cystic type of metastatic adenocarcinoma of the jaw. A: Coronal cone beam computed tomography (CBCT), is the same case as in Figure 1E; B: Oblique sagittal spiral-CT; C: CBCT revealed homogeneous radiodensity of the lesions (arrow) with geographic margins.

Figure 3 Radiological classifications and lesion margins in 14 patients with metastatic adenocarcinoma of the jaw.

Figure 4 A patient with metastatic adenocarcinoma of the jaw of primary liver cancer. A: Intraoral image before tooth extraction showed swelling of the gingival surrounding the wisdom tooth (arrow); B: Panorama radiograph before tooth extraction showed periodontal bone loss around the involved tooth (arrow); C: At a two-month follow-up visit, the extraction wound did not heal completely; D: Four months after tooth extraction, oblique sagittal cone beam computed tomography (CT) showed lesion (arrow) turned bulky with a permeative margin. The wall of the inferior alveolar nerve was invisible; E: Immunohistochemistry for the expression of CK8/18 revealed uniform positivity in the cytoplasm of tumour cells (Magnification: 100 ×); F: Immunohistochemistry for the expression of Ki-67 revealed scattered positivity in more than 65% of the tumour cells (Magnification: 100 ×); G: Positron emission tomography-CT scans showed asymptomatic hepatocellular carcinoma as the primary site and multiple metastases mainly involving the right mandible, spine, and bilateral pelvic bone (arrows).