Mandibular metastasis revealing a prostate adenocarcinoma
Objectives: We present a case of metastatic adenocarcinoma of the prostate, which presented with a metastatic lesion in the mandible as the initial manifestation.
Methods: Case report
Results: A 79-year-old male patient presented to our outpatient clinic with an 8 months history of numbness and swelling in the left lower facial region. The patient’s medical history included chronic smoking with 25 years of abstinence and controlled persistent atrial fibrillation.
Extra oral physical examination revealed a left perimandibular hard swelling and confirmed altered sensation in the distribution of the inferior alveolar nerve on the left. There was no palpable lymph node in the neck region. The intraoral physical examination revealed a swelling with vestibular obliteration in the posterior left alveolar ridge of the mandible. The swelling was nontender, fixed, bony hard in consistency and the surrounding soft tissues were intact.
The panoramic radiograph revealed diffuse radiolucent lesion with ill-defined borders in the left mandibular angle region.
A CT scan was then performed showing an extensive osteosclerotic oval-shaped mass within the left mandibular ramus with a sunburst periosteal reaction and an invasion of the overlying soft tissue.
An incisional biopsy of both the hard and soft tissue was performed under local anaesthesia. Histological examination of the specimen revealed moderately differentiated adenocarcinoma. Immunohistochemical evaluation demonstrated diffuse positivity for prostate specific antigen (PSA), and negative expression for carcinoembryonic antigen and anti-alpha1-antichymotrypsin.
Based on the histopathological examination, a final diagnosis of metastatic prostatic adenocarcinoma was given.
Thereafter, the patient was sent to urological consultation. Digital rectal examination found a large, asymmetrical prostate with hard consistency and histopathological analysis of a transrectal prostate biopsy confirmed prostate adenocarcinoma. In parallel, a thoracic-abdominal-pelvic CT scan was performed showing several bone and pulmonary metastases.
Conclusions: Our case report highlights the importance of proper history taken and a thorough clinical examination completed at the slightest doubt with histological study.