Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2021.407
Autopsy and Case Reports
Clinical Case Report

Metastasis of mucinous breast carcinoma to the lower alveolus as initial presentation: a diagnostic dilemma

Priyadarshini Guha; Zachariah Chowdhury

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Abstract

Metastases in the oral cavity are rare and comprise approximately 1% of all oral malignancies. They usually involve the jaws but may also be found in the soft tissues and salivary glands. Women's most common metastatic malignancies are from primary breast cancers. However, metastasis of mucinous breast carcinoma to the lower alveolus mimicking an aggressive primary malignancy as the initial presentation is exceptionally uncommon. We describe the case of a 66-year-old lady with an ulceroproliferative growth in the right lower alveolus. The lesion eroded the mandible and involved the adjacent soft tissues with no prior history of lesion anywhere else. The lesion clinically mimicked a squamous cell carcinoma and masqueraded as a salivary gland mucinous adenocarcinoma on histopathology. The possibility of a metastatic lesion from the breast rather than a primary of the alveolus was also entertained, aided by the immunohistochemical findings of positivity of the tumor cells for GATA3. A positron emission tomography (PET) scan was undertaken to ascertain the primary site. It detected a hypermetabolic lesion in the left breast, which biopsy revealed mucinous breast carcinoma on histopathological evaluation. Metastasis of breast mucinous carcinoma by the hematogenous route is extremely rare; very few cases have been reported. This case illustrates the diagnostic challenges such a lesion can pose to the surgeon and the pathologist. In the advent of such lesions being the initial clinical presentation, a vigilant clinicopathological and radiological assessment is essential to detect the primary.

Keywords

Adenocarcinoma, Mucinous, Breast, GATA3 Transcription Factor, Gingival, Jaw

References

1 Dumitru A, Procop A, Iliesiu A, et al. Mucinous breast cancer: a review study of 5 year experience from a hospital-based series of cases. Maedica. 2015;10(1):14-8. PMid:26225144.

2 Budzik MP, Fudalej MM, Badowska-Kozakiewicz AM. Histopathological analysis of mucinous breast cancer subtypes and comparison with invasive carcinoma of no special type. Sci Rep. 2021;11(1):5770. http://dx.doi.org/10.1038/s41598-021-85309-z. PMid:33707745.

3 Weigelt B, Horlings HM, Kreike B, et al. Refinement of breast cancer classification by molecular characterization of histological special types. J Pathol. 2008;216(2):141-50. http://dx.doi.org/10.1002/path.2407. PMid:18720457.

4 Bae SY, Choi MY, Cho DH, Lee JE, Nam SJ, Yang JH. Mucinous carcinoma of the breast in comparison with invasive ductal carcinoma: clinicopathologic characteristics and prognosis. J Breast Cancer. 2011;14(4):308-13. http://dx.doi.org/10.4048/jbc.2011.14.4.308. PMid:22323918.

5 Natal RA, Derchain SF, Pavanello M, Paiva GR, Sarian LO, Vassallo J. Expression of unusual immunohistochemical markers in mucinous breast carcinoma. Acta Histochem. 2017;119(3):327-36. http://dx.doi.org/10.1016/j.acthis.2017.03.002. PMid:28336164.

6 Wu Z, Tang J, Li Y, Lu H, Xu J, Lv D. Successful management of rare gingival metastasis from gastric adenocarcinoma: a case report and literature review. World J Surg Oncol. 2017;15(1):141. http://dx.doi.org/10.1186/s12957-017-1215-3. PMid:28764790.

7 Murillo J, Bagan JV, Hens E, Diaz JM, Leopoldo M. Tumors metastasizing to the oral cavity: a study of 16 cases. J Oral Maxillofac Surg. 2013;71(9):1545-51. http://dx.doi.org/10.1016/j.joms.2013.03.017. PMid:23800673.

8 Owosho AA, Xu B, Kadempour A, et al. Metastatic solid tumors to the jaw and oral soft tissue: a retrospective clinical analysis of 44 patients from a single institution. J Craniomaxillofac Surg. 2016;44(8):1047-53. http://dx.doi.org/10.1016/j.jcms.2016.05.013. PMid:27270028.

9 Alath P, Kapila K, Hussein S, et al. Parotid gland metastasis of breast cancer diagnosed on fine needle aspiration cytology: case report and review of literature. Cytopathology. 2014;25(5):346-8. PMid:24138676.

10 Varghese G, Singh SP, Sreela LS. A rare case of breast carcinoma metastasis to mandible and vertebrae. Natl J Maxillofac Surg. 2014;5(2):184-7. http://dx.doi.org/10.4103/0975-5950.154832. PMid:25937731.

11 Kechagias N, Ntomouchtsis A, Patrikidou A, Christoforidou B, Andreadis C, Vahtsevanos K. Metastasis of a ductal breast carcinoma to the buccal mucosa of the mandible with tooth involvement. Oral Maxillofac Surg. 2012;16(4):377-81. http://dx.doi.org/10.1007/s10006-011-0300-y. PMid:22083239.

12 Ha KY, Deleon P, Deleon W. Invasive mucinous carcinoma of the breast. Proc Bayl Univ Med Cent. 2013;26(3):295-7. http://dx.doi.org/10.1080/08998280.2013.11928989. PMid:23814397.

13 Spreafico R, Nicoletti G, Ferrario F, Scanziani R, Grasso M. Parotid metastasis from renal cell carcinoma: a case report and review of the literature. Acta Otorhinolaryngol Ital. 2008;28(5):266-8. PMid:19186459.

14 Pozzi EC, Altermatt HJ, Rees TD, Bornstein MM. Exophytic mass of the gingiva as the first manifestation of metastatic pulmonary adenocarcinoma. J Periodontol. 2008;79(1):187-91. http://dx.doi.org/10.1902/jop.2008.070246. PMid:18166110.

15 Baum SH, Mohr C. Metastases from distant primary tumours on the head and neck: clinical manifestation and diagnostics of 91 cases. Oral Maxillofac Surg. 2018;22(2):119-28. http://dx.doi.org/10.1007/s10006-018-0677-y. PMid:29344820.

16 Gök M, Topal U, Öz B, Akgün H, Akcan AC, Sözüer EM. Comparison of clinical features and treatment results of mix mucinous carcinomas and other atypical carcinomas of the breast. Eur J Breast Health. 2019;15(4):222-8. http://dx.doi.org/10.5152/ejbh.2019.5032. PMid:31620680.

17 Poulias E, Melakopoulos I, Tosios K. Metastatic breast carcinoma in the mandible presenting as a periodontal abscess: a case report. J Med Case Rep. 2011;5(1):265. http://dx.doi.org/10.1186/1752-1947-5-265. PMid:21722359.
 


Submitted date:
08/13/2021

Accepted date:
10/15/2022

Publication date:
11/03/2022

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