Metastatic Breast Carcinoma Initially Diagnosed as Pulpal/Periapical Disease: A Case Report

Introduction: Metastatic tumors to oral cavity and jaws are rare, and mandible is the most commonly involved location. Because the most common jaw symptom is pain, these lesions could be misdiagnosed as pathologic entities with dental origin. In this article a case of metastatic breast carcinoma initially diagnosed as pulpal/periapical disease is presented and discussed. Methods: A 40-year-old female patient was referred to our department with vague pain in right mandibular area. Clinical and radiographic examinations were performed, leading to the initial diagnosis. Patient's medical history was reevaluated, and an incisional biopsy was performed to confirm the final diagnosis. Results: Regarding the initial signs and symptoms, a pulpal/periapical inflammatory process was considered in the differential diagnosis. Because lip paresthesia was also noted, a more aggressive process was suspected. Patient's medical records and histopathologic slides were requested and reviewed carefully. The diagnosis of metastatic breast carcinoma was confirmed by comparing the histopathologic findings of the jaw lesion with previous slides of the breast. Conclusions: Despite their rarity, metastatic tumors should be considered in the differential diagnosis of inflammatory and reactive lesions of the jaws. These lesions might be diagnosed first by the patient's dentist or by the maxillofacial surgeon. This case emphasized the importance of a complete and careful work-up with particular attention to detailed medical history as well as careful clinical and radiographic inspection for unusual signs and symptoms. (J Endod 2010;36:922-925)