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Scientific paper - Case study
Challenges in the diagnosis of mandible metastasis: a case report
Medicina Fluminensis, 58 (2022), 2; 159-164. https://doi.org/10.21860/medflum2022_275137
Gudelj, Sara; Belušić-Gobić, Margita

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Gudelj, S. & Belušić Gobić, M. (2022). Challenges in the diagnosis of mandible metastasis: a case report. Medicina Fluminensis, 58. (2), 159-164. doi: 10.21860/medflum2022_275137

Gudelj, Sara and Margita Belušić Gobić. "Challenges in the diagnosis of mandible metastasis: a case report." Medicina Fluminensis, vol. 58, no. 2, 2022, pp. 159-164. https://doi.org/10.21860/medflum2022_275137

Gudelj, Sara and Margita Belušić Gobić. "Challenges in the diagnosis of mandible metastasis: a case report." Medicina Fluminensis 58, no. 2 (2022): 159-164. https://doi.org/10.21860/medflum2022_275137

Gudelj, S. and Belušić Gobić, M. (2022) 'Challenges in the diagnosis of mandible metastasis: a case report', Medicina Fluminensis, 58(2), pp. 159-164. doi: 10.21860/medflum2022_275137

Gudelj S, Belušić Gobić M. Challenges in the diagnosis of mandible metastasis: a case report. Medicina Fluminensis [Internet]. 2022 [cited 2024 November 23];58(2):159-164. doi: 10.21860/medflum2022_275137

S. Gudelj and M. Belušić Gobić, "Challenges in the diagnosis of mandible metastasis: a case report", Medicina Fluminensis, vol. 58, no. 2, pp. 159-164, 2022. [Online]. Available at: https://urn.nsk.hr/urn:nbn:hr:184:953064. [Accessed: 23 November 2024]

Metadata
Title (english)Challenges in the diagnosis of mandible metastasis: a case report
Title (croatian)Izazovi u dijagnostici metastaza mandibule: prikaz slučaja
AuthorSara Gudelj https://orcid.org/0000-0002-9250-3523
AuthorMargita Belušić-Gobić
Author's institutionUniversity of Rijeka
Faculty of Medicine
(Department of Oral Surgery)
Scientific / art field,
discipline and subdiscipline		BIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Abstract (english)
Abstract. Aim: To report the clinical course of a patient with long-lasting pain and swelling of mandible who was subsequently diagnosed with large cell neuroendocrine carcinoma (LCNEC) of the lung and to point out the importance of expanding the diagnostic approach. Case report: A 61-year-old female patient was referred to the Department of maxillofacial surgery due to severe pain in the area of temporomandibular joint (TMJ) spreading to the upper and lower jaw. Physical examination revealed tenderness, swelling and pain of the preauricular area. MR imaging showed anterior disc displacement with degenerative signs on the left side which indicated arthrocentesis. It resulted with clinical improvement that lasted for 1.6 years. Newly made orthopantomogram revealed unclear changes of the left mandibular corpus. Due to the unclear diagnosis patient underwent biopsy on two occasions, which excluded IgG4 disease, other rheumatology and hematology diseases as well as the tumor. Five years after the initial admission, the patient stated the occasional dyspnea and cough leading to administration of the chest RTG, showing visible round mass in the upper left lobe of the lung. PET/ CT showed accumulation of radiopharmaceutical substance in the corresponded area, affected regional and distant lymph nodes and accumulation within mandible. Somatostatin receptor scintigraphy confirmed the diagnosis, which may indicate the possibility of distant malignancies. Wedge resection of the lung mass was performed and pathohistological examination confirmed the large-cell neuroendocrine carcinoma (LCNEC) stage 3. Chemotherapy was administrated. Patient referred to an emergency medical tract due to the threatening cardiac tamponade and died 11 days after. Conclusions: Mandibular metastases are often presented by atypical signs and symptoms and often present the first sign of the malignant disease. Broad spectrum of examinations must be performed in order to prove or exclude distant malignancies so the best therapy option can be provided.
Abstract (croatian)
Sažetak. Cilj: Cilj je ovog članka prikazati klinički tijek pacijentice s dugotrajnom boli i oticanjem donje čeljusti kojoj je naknadno dijagnosticiran neuroendokrini karcinom velikih stanica pluća (engl. large-cell neuroendocrine carcinoma; LCNEC) i ukazati na važnost proširenja dijagnostičkog pristupa. Prikaz slučaja: Šezdesetjednogodišnja pacijentica upućena je na Odjel za maksilofacijalnu kirurgiju zbog jakih bolova u području čeljusnog zgloba (engl. temporomandibular joint; TMJ) koji se šire na gornju i donju čeljust. Fizikalnim pregledom otkrivena je osjetljivost, oteklina i bol preaurikularnog područja. MR snimanje pokazalo je anteriorni pomak diska s degenerativnim znakovima na lijevoj strani. Obavljena artrocenteza rezultirala je kliničkim poboljšanjem koje je trajalo 1,6 godina. Na novoučinjenim panoramskim snimkama čeljusti uočene su promjene nejasne etiologije, lijeve strane mandibule. Zbog nejasne dijagnoze, u dva navrata izvršena je biopsija kosti koja je isključila IgG4 bolest, druge reumatološke i hematološke bolesti, kao i tumor. Pet godina nakon početnog prijama, zbog pojave dispneje i kašlja upućuje se na radiogram (RTG) prsnih organa koji pokazuje vidljivu okruglu masu u gornjem lijevom režnju pluća. PET/CT je pokazao nakupljanje radiofarmaka u navedenom području, zahvaćene regionalne i udaljene limfne čvorove te akumulaciju unutar mandibule. Scintigrafija somatostatinskih receptora potvrdila je navedeno, što upućuje na mogućnost prisutnosti udaljenih metastaza u području mandibule. Izvršena je klinasta resekcija plućne mase koja je patohistološkom analizom definirana kao neuroendokrini karcinom velikih stanica. Nakon dijagnostičke obrade aplicirana je kemoterapija. Nekoliko mjeseci nakon toga pacijentica se zaprima u ambulantu hitne pomoći zbog prijeteće tamponade srca te umire jedanaest dana nakon incidenta. Zaključci: Metastaze na donjoj čeljusti često se prezentiraju atipičnim znakovima i simptomima te mogu predstavljati prvi znak zloćudne bolesti. Detaljnom kliničkom obradom potrebno je dokazati ili isključiti maligne metastaze kako bi se pacijentima pružila najbolja moguća skrb.
Keywords (english)
Keywords (croatian)
Languageenglish
Publication typeScientific paper - Case study
Publication statusPublished
Peer reviewPeer review
Publication versionPublished version
Journal titleMedicina Fluminensis
Numberingvol. 58, no. 2, pp. 159-164
p-ISSN1847-6864
e-ISSN1848-820X
DOIhttps://doi.org/10.21860/medflum2022_275137
URN:NBNurn:nbn:hr:184:953064
Publication2022
Document URLhttps://hrcak.srce.hr/275137
Type of resourceText
Access conditionsOpen access
Terms of useLicence Attribution 4.0 International (CC BY 4.0) icon
Created on2022-06-14 12:54:42