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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 29  |  Issue : 2  |  Page : 122-124

A rare presentation of prostate adenocarcinoma metastatic to the maxilla


Department of Oral Medicine and Radiology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India

Date of Submission15-Dec-2015
Date of Acceptance24-Oct-2017
Date of Web Publication9-Nov-2017

Correspondence Address:
Venkata S Prathi
Department of Oral Medicine and Radiology, Narayana Dental College and Hospital, Chinthareddypalem, Nellore, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.JIAOMR_252_15

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   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 Top


Oral cancer is the most common cancer in India. Metastatic tumors of the oral cavity [1] are uncommon and originate from primary sites located in the breast, prostrate,[2] lung, thyroid, and kidney.[3],[4] 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.[5] 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 Top


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 1: Extraoral photograph of the patient

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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 Top


Metastasis of the adenocarcinoma of the prostate to the oral cavity is rare [2] and account for 1% of all the oral malignancies.[1],[3],[4],[5] Metastases to oral hard and soft tissues have been reported in literature.[1],[4],[5] Most reported oral metastases to soft tissues are gingiva, alveolar mucosa, buccal mucosa, and tongue.[1],[4],[6] Surprisingly, mandible and palate are the only metastatic sites from prostate, and no single case was reported involving the maxilla till today.[1],[2] Rutsatz et al. reported 1008 patients with craniofacial malignancies and found only 5 patients (0.5%) with metastatic tumors in the jaws.[3] Piattelli et al. reported 390 oral malignancies, of which 22 cases (5.6%) were metastatic tumors to jaws.[3],[5] 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.[6] Here, we are present a rare case report of prostate adenocarcinoma metastatic to maxilla.


   Conclusion Top


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.[7]

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

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kumar GS, Manjunatha BS. Metastatic tumors to the jaws and oral cavity. J Oral Maxillofac Pathol 2013;17:71-5.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Pontes HA, Pontes FS, Fonseca FP, Sena-Filho M, dos Santos Pinto D, Soares PT, et al. Prostate adenocarcinoma metastasis to the oral cavity. J Craniofac Surg 2014;25:723-5.  Back to cited text no. 2
[PUBMED]    
3.
Menezes JD, Cappellari PF, Capelari MM, Gonçalves PZ, Toledo GL, Toledo Filho JL, et al. Mandibular metastasis of adenocarcinoma from prostate cancer: Case report according to epidemiology and current therapeutical trends of the advanced prostate cancer. J Appl Oral Sci 2013;21:490-5.  Back to cited text no. 3
    
4.
Damodaran D, Kathiresan N, Satheesan B. Oral cavity metastasis: An unusual presentation of carcinoma prostate. Indian J Urol 2008;24:112-3.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Piattelli A, Fioroni M, Rubini C. Gingival metastasis from a prostate adenocarcinoma: Report of a case. J Periodontol 1999;70:441-4.  Back to cited text no. 5
[PUBMED]    
6.
Daley T, Darling MR. Metastases to the mouth and jaws: A contemporary Canadian experience. J Can Dent Assoc 2011;77:b67.  Back to cited text no. 6
[PUBMED]    
7.
Buchmann L, Conlee J, Hunt J, Agarwal J, White S. Psychosocial distress is prevalent in head and neck cancer patients. Laryngoscope 2013;123:1424-9.  Back to cited text no. 7
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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