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      Non-Seminomatous Germ Cell Tumor Metastasis to the Jaw: An Imaging Case Report

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          Abstract

          Testicular cancer typically spreads to the lymph nodes, but hematogenous dissemination to distant organs can also occur. Bone metastasis is uncommon and is thought to be a poor prognostic indicator. Jaw metastasis is exceedingly rare but is of great clinical significance, since it may be the first sign of an occult testicular cancer or the first evidence of relapse of a known tumor. Herein, we report the first case describing the imaging and clinical findings of a non-seminomatous germ cell tumor with jaw metastasis at diagnosis.

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          Metastatic tumours to the oral cavity - pathogenesis and analysis of 673 cases.

          Abraham Hirshberg, Ilana Kaplan, Anna Shnaiderman … (2008)
          The oral region is an uncommon site for metastatic tumour cell colonization and is usually evidence of a wide spread disease. In 25% of cases, oral metastases were found to be the first sign of the metastatic spread and in 23% it was the first indication of an undiscovered malignancy at a distant site. The jawbones, particularly the mandible, were more frequently affected than the oral soft tissues (2:1). In the oral soft tissues, the attached gingiva was the most commonly affected site (54%). The major primary sites presenting oral metastases were the lung, kidney, liver, and prostate for men, breast, female genital organs (FGO), kidney, and colo-rectum for women. The primary site differs according to oral site colonization, in men the lung was the most common primary site affecting both the jawbones and oral mucosa (22% and 31.3%, respectively) followed by the prostate gland in the jawbones (11%) and kidney in the oral soft tissues (14%). In women, the breast was the most common primary tumour affecting the jawbones and soft tissues (41% and 24.3%, respectively), followed by the adrenal and female genital organs (FGO) in the jawbones (7.7%) and FGO in the soft tissues (14.8%). The clinical presentation of the metastatic lesions differ between the various sites in the oral region. In the jawbones most patients complain of swelling, pain and paresthesia which developed in a relative short period. Early manifestation of the gingival metastases resembled a hyperplastic or reactive lesion, such as pyogenic granuloma, peripheral giant cell granuloma, or fibrous epulis. Because of its rarity, the diagnosis of a metastatic lesion in the oral region is challenging, both to the clinician and to the pathologist, in recognizing that a lesion is metastatic and in determining the site of origin. The clinical presentation of a metastatic lesion in the oral cavity can be deceiving leading to a misdiagnosis of a benign process, therefore, in any case where the clinical presentation is unusual especially in patients with a known malignant disease a biopsy is mandatory.
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            Testicular Germ-Cell Cancer

            George Bosl, Robert Motzer (1997)
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              Metastatic tumors to the jawbones: analysis of 390 cases.

              A Hirshberg, P Leibovich, A Buchner (1994)
              A review of the English language literature revealed 390 well-documented cases of metastatic lesions to the jawbones. Most metastatic lesions were diagnosed in patients in their fifth to seventh decade. The primary site differed between the genders: for women, it was the breast followed by the adrenal, colo-rectum, female genital organs and thyroid; for men, it was the lung, followed by the prostate, kidney, bone and adrenal. The most common location of the metastatic tumors was the mandible, with the molar area the most frequent site involved. In about 30% of cases the oral lesion was the first sign of the malignant disease. The present data are compared with those of metastatic tumors to the oral mucosa and a view on the possible pathogenesis is presented.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Iran J Radiol
                Journal ID (iso-abbrev): Iran J Radiol
                Journal ID (doi): 10.5812/iranjradiol
                Journal ID (publisher-id): Kowsar
                Title: Iranian Journal of Radiology
                Publisher: Kowsar
                ISSN (Print): 1735-1065
                ISSN (Electronic): 2008-2711
                Publication date (Electronic): 25 April 2016
                Publication date Collection: July 2016
                Volume: 13
                Issue: 3
                Electronic Location Identifier: e27812
                Affiliations
                [1 ]Department of Radiology, University Hospital Policlinico “G. Rodolico”, Catania, Italy
                [2 ]Department of Oncology, ARNAS Garibaldi, Catania, Italy
                Author notes
                [* ]Corresponding author: Mario Uccello, Department of Oncology, ARNAS Garibaldi, Catania, Italy. Tel: +39-0957595039, Fax: +39-0957595041, E-mail: mario_uccello@ 123456hotmail.it
                Article
                DOI: 10.5812/iranjradiol.27812
                PMC ID: 5106575
                SO-VID: aa86171e-a86c-4ccf-a573-a4971991ca27
                Copyright © Copyright © 2016, Tehran University of Medical Sciences and Iranian Society of Radiology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

                History
                Date received : 08 February 2015
                Date revision received : 05 May 2015
                Date accepted : 19 May 2015
                Categories
                Subject: Head & Neck Imaging

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: jaw,bone,metastasis,testicular cancer,germ cell tumors
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: jaw, bone, metastasis, testicular cancer, germ cell tumors

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