Mandible metastases - prostate carcinoma

Case contributed by Dr Ian Bickle

Presentation

Presented with a large left-sided jaw mass to the OMF clinic.

Patient Data

Age: 70 years
Gender: Male

Expansile destructive lesion in the left body of the mandible with a large soft tissue component.

Large lucent destructive lesion with both buccal and lingual cortical destruction in the left body of the mandible.

Smaller lucent lesion with minor cortical destruction on the buccal aspect in the right mandibular body.

3D volume rendered images of the mandible - the extent of the bony destruction is evident.

Diffuse sclerotic metastases throughtout the bony skeleton.

Prostatomegaly.

Malignant ilac lymph nodes.

Pulmonary metastases.

A surgical biopsy confirms the left sided mandibular mass to represent a prostate metastasis.

Case Discussion

The mandible is an uncommon site for metastatic disease.

Prostate carcinoma is a tumor well known for its predisposition to metastasize to the bone, but it virtually always sclerotic in nature, as with the diffuse metastases elsewhere in this patient, with the exception on the bilateral mandibular lesions which are lytic in nature.

A double, but histologically proven radiological curiosity.  One of the more unusual ways to present with first diagnosis of prostate carcinoma with a jaw mass to OMF.

The patients PSA was >100 units with iliac node metastases on body CT.

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