Many faces of Metastases in the Oral and Maxillofacial Region: Challenge for Radiologists

Abstract: Introduction: Metastases of distant tumors to Oral and Maxillofacial (OMF) region are uncommon, and their radiological presentation can vary significantly. There are many reports of unusual cases of metastases in OMF region, pointing out challenges for clinicians and pathologists, but still barely addressing the radiological aspect. Discussion: We present 5 cases of metastases to OMF region: 2 located in the posterior mandible, and 3 of them in soft tissues- involving tongue, pterygoid musculature and parotid gland. Four of the patients were males, and one patient was female, all above the age of 60. The primary tumor origins were: lung, skin, prostate, one male and one female breast. Besides their neoplastic radiological pattern, the presented cases induced diagnostic dilemmas due to atypical appearance, unusual localization, or patient’s unawareness and lack of medical documentation of malignant disease. As a first sign of prostate cancer a mixed density bone lesion was detected followed with atypical sunburst periosteal reaction, while non-homogenous, bilateral mass in pterygoid musculature was the first evidence of dissemination of primary male breast cancer. Summary: Metastatic tumors are of an indisputably clinical significance, as their appearance may be the first sign of a primary malignancy at a distant site of origin, or the first evidence of dissemination of a known tumor. Despite variable radiological presentation, radiologists should keep a high level of suspicion for metastases and carefully select cases that require additional imaging.