BREAST CANCER METASTASIS TO THE TOOTH!!

When I did the bone scan in middle of Dec last year, the technician asked me whether I was suffering from a toothache. My upper molar tooth on the right seemed to take up the radioactive material. I had to agree with her that the uptake was due to the bad tooth, for that tooth was a bad tooth indeed, but then it was not that bad, and it was not hurting at all, not even until now. I agreed that it was and is a bad tooth because it had descended from its place slightly, as there was no opposing lower molar. However, the thought about the active lesion can't be dismissed, especially so when there was no pain and until now there was only slight pain on pressure on the gum and underlying bone. There is also a mild swelling of the mucosa and a small abscess.

So, I've been searching to pacify my subconscious worrying diagnosis of metastasis to the tooth, however ridiculous it is; PET scan won't help any further, bone scan is better than PET scan for bone met. The best is of course biopsy, but I am not giving in to any form of biopsy --YET!

This article explains why my right upper molar tooth is susceptible, the so called The Hedgehog Pathway Conditions the Bone Micro environment for Osteolytic Metastasis of Breast Cancer.

In simple phrase, my weak tooth, though it is still intact and not decaying, it is weakened as it has slightly detached from its socket and lacks oxygen, thus creating a micro environment conducive to metastasis. I am not having a toothache, but my tooth lights up on bone scan and there is small abscess forming in the gum right now. No wonder my mouth is so foul smelling lately! It could be a gum boil, still needing urgent attention from the dentist.

Now, just now, I found a publication that alerted me to seek treatment from the oncologist and dentist.  Metastasis of a ductal breast carcinoma to the buccal mucosa of the mandible with tooth involvement. At least now, eventhough the threat appeared much more real, I am feeling better, sort of the return of the warrrior spirit similar to that felt upon the first diagnosis.

So, what to do now? Let me try my way first; if it seemed not working then I'll go to a dentist. He or she can take x-rays or do a biopsy.

This case show a similar presentation, except that she had taken bisphosphonate and suspected to suffer from bisphosphonate-induced jaw osteonecrosis: Source: click here.

Metastatic breast carcinoma in the mandible presenting as a periodontal abscess: a case report.
Poulias E, Melakopoulos I, Tosios K.

ABSTRACT:

INTRODUCTION: Tumors can metastasize to the oral cavity and affect the jaws, soft tissue and salivary glands. Oral cavity metastases are considered rare and represent approximately 1% of all oral malignancies. Because of their rarity and atypical clinical and radiographic appearance, metastatic lesions are considered a diagnostic challenge. The purpose of this report is to present a rare case of a metastatic breast carcinoma mimicking a periodontal abscess in the mandible.

CASE PRESENTATION: A 55-year-old Caucasian woman was referred to our clinic for evaluation of bisphosphonate-induced jaw osteonecrosis. She had undergone modified radical mastectomy with axillary lymph node dissection for invasive ductal carcinoma of the left breast. Her clinical examination showed diffuse swelling and a periodontal pocket of 6 mm exhibiting suppuration in the posterior right mandible. Moreover, paresthesia of the lower right lip and chin was noted. There were no significant radiographic findings other than alveolar bone loss due to her periodontal disease. Although the lesion resembled a periodontal abscess, metastatic carcinoma of the breast was suspected on the basis of the patient's medical history. The area was biopsied, and histological analysis confirmed the final diagnosis of metastatic breast carcinoma.

CONCLUSION: The general dentist or dental specialist should maintain a high level of suspicion while evaluating patients with a history of cancer. Paresthesias of the lower lip and the chin should be considered ominous signs of metastatic disease. This case highlights the importance of the value of a detailed medical history and thorough clinical examination for the early detection of metastatic tumors in the oral cavity.

Another case: Click here.

Metastasis of a ductal breast carcinoma to the buccal mucosa of the mandible with tooth involvement.
Kechagias N, Ntomouchtsis A, Patrikidou A, Christoforidou B, Andreadis C, Vahtsevanos K.

Abstract

BACKGROUND: We present a metastatic tumour from the breast to the gingiva, with the rare finding of tooth invasion. Metastatic tumours to the oral region are uncommon. The breast is the most common primary site for metastatic tumours to the jawbones in women, with the mandible being most often affected.

CASE REPORT: We report the case of a 52-year-old Caucasian woman who presented with a swelling of the buccal mucosa in the molar region of the left mandible. Biopsy revealed a metastatic lesion, with involvement of the two adjacent molars. Immunohistochemical analysis ruled out other malignancies and confirmed the diagnosis of a ductal breast carcinoma origin.

DISCUSSION: Management in such cases should be in the context of the treatment of a metastatic disease that could prolong survival and improve quality of life, but is not curative. Tooth invasion has been described since 1910 for different primary malignancies with distant metastases to the oral cavity. This report seems to describe the second case in the literature of a metastatic breast carcinoma to the mandible with tooth invasion. Management in such cases should be in the context of the treatment of a metastatic disease that could prolong survival and improve quality of life, but is not curative.