Unique and rare bone metastases from occult primary cancer. Our experience

The aim of our study is to describe the rare location of metastasis cancers (kidney and prostate) in the jaw bones (maxillary branch and the condyle); this is the first and the only sign of disease.

Two patients referred to us for a swelling in his left preauricolar region with a moderate pain. They underwent a radiologic and bioptic examinations that showed a metastasis which could arise from a primary prostatic and renal adenocarcinoma. The patients underwent surgical treatment (Subtotal-emimandibulectomy and reconstruction with metallic endoprosthesis).

The final follow up for the first patient was acceptable and without any motor or sensory deficit. The patient also underwent chemotherapy for his primary tumour and radiotherapy of his mandibular condyle metastasis during the preoperative stage. The final follow-up of the second patient was performer two years after the surgery and it did not show any recurrence and after about 18 months from surgery has performed dentistry rehabilitation. The patient had a chemotherapy treatment with the administration of bisphosphonates for the presence of skeletal metastases.

Just 1% of carcinomas metastasizes in jaw bones. The low rate is linked to the low active bone marrow content in jaw bones of adult patients. For the prostatic and breast adenocarcinomas the neoplastic embolis reaches the skeleton directly, passing through the vertebral venous system (Batson's hypothesis). Early diagnosis made the treatment both of the primary tumour and of its recurrence (single metastasis) more effective.