|Year : 2017 | Volume
| Issue : 2 | Page : 122-124
A rare presentation of prostate adenocarcinoma metastatic to the maxilla
Venkata S Prathi, Rakesh K Manne, Kannan Natarajan, Beeraka Swapna
Department of Oral Medicine and Radiology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
|Date of Submission||15-Dec-2015|
|Date of Acceptance||24-Oct-2017|
|Date of Web Publication||9-Nov-2017|
Venkata S Prathi
Department of Oral Medicine and Radiology, Narayana Dental College and Hospital, Chinthareddypalem, Nellore, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Metastatic tumors of the orofacial region are uncommon and may occur in the oral soft tissues and jaw bones. The occurrence of prostate as the primary site for jaw metastasis is extremely rare. Mandible and palate are the common prostate metastatic sites. Here, we present a rare case of prostate adenocarcinoma metastatic to maxilla.
Keywords: Adenocarcinoma, metastasis, prostate cancer
|How to cite this article:|
Prathi VS, Manne RK, Natarajan K, Swapna B. A rare presentation of prostate adenocarcinoma metastatic to the maxilla. J Indian Acad Oral Med Radiol 2017;29:122-4
|How to cite this URL:|
Prathi VS, Manne RK, Natarajan K, Swapna B. A rare presentation of prostate adenocarcinoma metastatic to the maxilla. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2020 Nov 26];29:122-4. Available from: https://www.jiaomr.in/text.asp?2017/29/2/122/217914
| Introduction|| |
Oral cancer is the most common cancer in India. Metastatic tumors of the oral cavity  are uncommon and originate from primary sites located in the breast, prostrate, lung, thyroid, and kidney., Prostate cancer is the second most common cancer and the sixth leading cause of cancer death among men worldwide. Prostate cancer incidence rates in India are low but not far behind compared to western counties. Prostate carcinoma are divided into two types adenocarcinoma arising from glandular acini and peripheral secondary ducts and carcinoma of large primary ducts. The occurrence of prostate as the primary site for jaw metastasis is extremely rare. We report a male patient who presented to our department with a nonhealing ulcer post extraction of the left maxillary molar. The nonhealing ulcer on evaluation was found to be prostate adenocarcinoma metastatic to the maxilla.
| Case Report|| |
A 73-year-old male patient [Figure 1] was referred to our department by a general dental practitioner for opinion and management of nonhealing ulcer of 15 days duration which developed post extraction of the left maxillary second molar. Patient's medical history was noncontributory. A solitary left submandibular lymph node was palpable, measuring around 2 × 1 cm in size, round in shape, and firm in consistency. The lymph node was fixed to the underlying structures [Figure 2], and there was no local rise in temperature. Intraoral examination showed decayed #13, 14, and 17, missing #12, 26, 27, 31, 32, 36, 37, 46, and 47, as well as generalized periodontitis. Alveolar mucosa showed a deep ulcer [Figure 3], measuring around 3 × 2 cm in size in the left maxillary posterior alveolar ridge at the extracted site, extending anteroposteriorly from distal surface of 25 to maxillary tuberosity and superoinferiorly from crest of the alveolar ridge of 26, 27 to 1 cm short toward the buccal sulcus on the buccal surface and extending 1 cm from the alveolar ridge towards lingual surface. The edge of the ulcer was inflamed, edematous, and raised. Floor of the ulcer was covered by yellowish-white slough. Margins and base of the ulcer were indurated and fixed to the underlying alveolar mucosa on palpation. Panoramic radiograph [Figure 4] showed maxillary bone involvement as saucer-shaped radiolucency with ill-defined borders. On correlating clinical and radiographic features, it was suggestive of carcinoma – left maxillary alveolus.
|Figure 2: Extraoral photograph of the patient showing enlarged left submandibular lymph node|
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|Figure 3: Intraoral photograph showing an ulcer on the left maxillary posterior ridge|
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|Figure 4: Panoramic radiograph showing saucer-shaped radiolucency in the left maxillary alveolar ridge region, extending medially from distal surface of 25 to the maxillary tuberosity, laterally|
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A small biopsy of the ulcer revealed presence of parakeratinized surface epithelium in association with a fibrovascular connective tissue [Figure 5]. The connective tissue showed aggregates of darkly stained cells, separated by fibrosis. Few cells were round with centrally placed nucleus and vacuolated cytoplasm, and few cells were arranged in the form of ducts, suggestive of poorly differentiated adenocarinoma. The patient was referred to the department of medical oncology, regional cancer center, Chennai for further evaluation and management. The emotionally distressed patient died due to cardiac arrest the next day.
|Figure 5: H and E stained showing parakeratinized surface epithelium in association with a fibrovascular connective tissue. The connective tissue showed aggregates of darkly stained cells, separated by fibrosis|
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| Discussion|| |
Metastasis of the adenocarcinoma of the prostate to the oral cavity is rare  and account for 1% of all the oral malignancies.,,, Metastases to oral hard and soft tissues have been reported in literature.,, Most reported oral metastases to soft tissues are gingiva, alveolar mucosa, buccal mucosa, and tongue.,, Surprisingly, mandible and palate are the only metastatic sites from prostate, and no single case was reported involving the maxilla till today., Rutsatz et al. reported 1008 patients with craniofacial malignancies and found only 5 patients (0.5%) with metastatic tumors in the jaws. Piattelli et al. reported 390 oral malignancies, of which 22 cases (5.6%) were metastatic tumors to jaws., Daley and Darling reported 8 oral metastases from prostate; the metastatic sites included 5 cases in the mandible, and 1 case each in the palate, alveolar mucosa, and buccal vestibule. Here, we are present a rare case report of prostate adenocarcinoma metastatic to maxilla.
| Conclusion|| |
Psychological distress is more common in cancer patients. Early detection and treatment of distress is more important in these patients. The consequences of untreated depression may be severe, affecting quality of life, treatment compliance, and survival rate. Suicidal tendencies are four times more common than normal population.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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