J Korean Assoc Oral Maxillofac Surg.  2016 Oct;42(5):301-306. 10.5125/jkaoms.2016.42.5.301.

Prostate adenocarcinoma mandibular metastasis associated with numb chin syndrome: a case report

• Kim IK
• Lee DH
• Cho HY
• Seo JH
• Park SH
• Kim JM

• KMID: 2356258
• DOI: http://doi.org/10.5125/jkaoms.2016.42.5.301

Abstract

The purpose of this study is to report a rare case of mandibular adenocarcinoma that was diagnosed due to metastasis from the prostate. Numb chin syndrome (NCS), which was associated with this case, is also discussed. Computed tomography (CT) and an intraoral incisional biopsy of the left mandibular area were performed. Urology consultation, hormone therapy, chemotherapy and follow-up radiographic images were administered. Histological examination of the incised specimen revealed moderately differentiated adenocarcinoma. The Gleason score was 8 (primary 4/secondary 4). Immunohistochemical features and radiographic results confirmed the diagnosis of metastasis from prostate adenocarcinoma, moderately differentiated. The patient's prostate-specific antigen (PSA) level was very high. After hormone treatment, the patient's PSA levels dropped gradually. Seventeen months later, in May 2015, the PSA level was elevated. The 18-month follow-up CT image indicated that the patient's condition was aggravated. Docetaxel chemotherapy was started in June 2015 (18 months later), and the sixth cycle of the therapy is in progress. Oral metastases that originate from prostate adenocarcinoma are rare and can induce various periosteal reactions. Hormone therapy, chemotherapy and close follow-up could be additional, appropriate treatment, and were applied in this case. Finally, NCS is a valuable indicator of metastatic disease in the mandible.

Keyword

Prostate adenocarcinoma; Oral metastases; Hormone therapy; Chemotherapy; Numb chin syndrome

MeSH Terms

Adenocarcinoma*
Biopsy
Chin*
Diagnosis
Drug Therapy
Follow-Up Studies
Mandible
Neoplasm Grading
Neoplasm Metastasis*
Prostate*
Prostate-Specific Antigen
Urology
Prostate-Specific Antigen

Figure

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  Fig. 1 A 6×7.7×7.2 cm3 sized enhancing mass with sunburst periosteal reaction in ramus, angle and posterior body of left mandible. A. Panorama (1st medical examination). B. Oropharynx computed tomography (CT) axial view (1st medical examination). C. Oropharynx CT coronal view (1st medical examination). Arrows indicate enhancing mass with sunburst periosteal reaction.

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  Fig. 2 Immunohistochemical stain for prostate-specific antigen (PSA–positive; cytokeratin 7, cytokeratin 20, TTF-1, and S100–negative) reveals diffuse strong positive result. A. Submucosal tissue (H&E staining, ×100). B. Submucosal tissue (PSA immunohistochemical staining, ×200).

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  Fig. 3 Active bone lesion in left (Lt.) mandible and right (Rt.) lateral 8th and 9th ribs, right posterior 9th to 11th ribs. A. Whole body bone scan: abnormal increased bony uptake in right lateral 8th and 9th ribs, right posterior 9th to 11th ribs. B. Mandible bone scan: abnormal increased bony uptake in left mandible. Arrows indicate active bone lesion.

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  Fig. 4 Sclerotic change with mild fluorodeoxyglucose (FDG) uptake in left mandible. Ten-month follow-up positron emission tomography-computed tomography. Arrows indicate sclerotic change in mandible.

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  Fig. 5 Follow-up computed tomography (CT). A. Mandible CT axial and coronal view (5 months). B. Mandible CT axial and coronal view (18 months). Arrows in Fig. 5. A indicate more decreased soft tissue mass than Fig 1. But arrows in Fig. 5. B show the aggravated soft tissue mass.

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