The body of the mandible especially the premolar-molar region is the most common site of metastasis in the oral cavity

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口腔病理科 On-Line KMU Student Bulletin

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原文題目(出處)： Metastatic follicular thyroid carcinoma to the mandible: a case report. Cases Journal 2009;2:6533

原文作者姓名： Ismail SB, Abraham MT, Zaini ZB, Yaacob HB, Zain RB 通訊作者學校： Department of Oral Pathology & Oral Medicine, Hospital

Sultan Abdul Halim, Sungai Petani, Kedah, Malaysia 報告者姓名(組別)：盧威利(Intern A組)

報告日期： 2009/10/13 內文：

Abstract and Introduction

z Metastatic lesions to the oro-facial region may be the first evidence of dissemination of an unknown tumour from its primary site.

z The present case emphasizes the importance of considering metastasis in the differential diagnosis of swelling related to loosening of teeth, even though the patient had no history of any malignant disease.

z Metastatic tumours to the jaw bones are more frequently reported than those in the oral mucosa. The body of the mandible especially the premolar-molar region is the most common site of metastasis in the oral cavity.

z Pain and/or paraesthesia are the most common clinical symptoms.

z Metastatic carcinoma占所有口腔malignancy的1%；Jaw metastases中：Thyroid carcinoma metastasizes占3.85%

Case report

C.C.: A 70-year-old Malay female patient complained of pain and swelling in the left side of the angle of the mandible.

P.I.: Three months earlier she had undergone extraction of the left mandibular second premolar for complaints of mobility and pain. Hypertension(+), diabetes(+), history of malignancy(-), smoking(-), alcohol(-), betel quid chewing(-)

O.E. and Radiographic finding:

z 3~4 cm firm swelling mass in left side of the mandible, form tooth 33~37 with bicortical expansion. The mucosa was an erythematous change. LN(-)

Biopsy: Thyroid follicles filled with colloid material (PAS)(+: thyroglobulin) Dx: metastatic follicular carcinoma of the thyroid.[Follicular thyroid carcinoma (FTC)]

Tx: thyroidectomy and radiotherapy.

Figure 1.

Swelling of the left gingival area. An intra-oral photograph showing the metastatic lesion at gingiva of the left mandibular premolar and molar area.

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Figure 2.

A 3-Dimentional CT scan. A three

dimensional CT scan showing the metastatic lesion.

Figure 3.

Histopathology of The Metastatic Lesion. A photomicrograph showing

well-differentiated thyroid follicles with abundant colloid (H&E;

Original magnification – 20X).

Discussion

z The common primary sites breast 21.8%

lung 12.6%

adrenal 8.7%

kidney 7.9%

bone 7.4%

colo-rectum 6.6%

prostate 5.6%

z Most metastatic tumours to the oral region occur in patients aged 40 to 70 years.

z In 1/3 of patients, oral metastasis may be the first evidence of metastasis from its primary site

z In the jaw, pain, swelling, loosening of tooth and paraesthesia are the most common clinical manifestations

z The most common radiographic presentation is a radiolucent lesion with ill-defined margins.不過有5%看不出什麼變化。

z Follicular thyroid carcinoma (FTC) is a well-differentiated tumour which

originates in follicular cells and resembles the normal microscopic pattern of the thyroid.

z Common cancer of thyroid: 1.papillary carcinoma >2.FTC

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z Immunohistochemical marker for FTC is thyroglobulin.

z Distant metastases occur in 10 to 15% of patients with differentiated thyroid carcinoma.其中常轉移到bone，其次是lung.很少轉移至口腔。

z Poor prognosis:An overall 10-year survival rate of 27% for bone metastasis of differentiated thyroid carcinoma, 40% survivors of distant follicular metastases after 5 years，因此早期發現對癒後很有幫助。

題號題目

1 關於甲狀腺癌(Carcinoma of thyroid)好發種類排序何者正確？

1. Papillary carcinoma 2. Follicular carcinoma 3. Medullary carcinoma 4. Anaplastic carcinoma (A) 1234

(B) 1324 (C) 2134 (D) 2143

答案(A) 出處：實用病理學P.414

題號題目

2 關於甲狀腺的敘述，何者正確？

(A) 甲狀腺可分泌甲狀腺素(T₃ & T4)，其中以T4占主要調節功能。

(B) 甲狀腺可分泌降鈣素，與副甲狀腺素共同作用達到加成效果。

(C) 甲狀腺濾泡充滿甲狀球蛋白(thyroglobulin)，亦可作為染色的指標(marker)。

(D) 甲狀腺合成及分泌與腦下腺後葉所分泌的甲狀腺刺激素(TSH)

有關。

答案(C) 出處：Wheater’s Functional Histology P.315~317