METASTATIC THYROID CARCINOMA TO THE MANDIBLE MIMICKING A VASCULAR MALFORMATION: CASE REPORT

Metastasis to the oral cavity rarely occurs and constitutes 1% of all oral cavity malignancies and have been mostly detected in the jaw bones and especially in the mandible. Thyroid cancers have accounted for up to 6% of the oral cavity metastases, occurring more frequently in follicular variants. Because of the hypervascularity of these tumors, the diagnosis of vascular malformation must be discussed and vascular control should be assured in order to avoid any hemorrhagic incident. In the current work, we present a rare case of a hypervascular mandibular metastasis of thyroid carcinoma of a 65 year old female patient. After examination and confirmation, a decision was taken to resect the metastatic mandibular mass in the same time of a total thyroidectomy. Because of the risk of excessive bleeding of the high flow mandibular lesion, the left external carotid artery was ligated first. The histopathologic study of the surgical specimen revealed a follicular thyroid carcinoma of the thyroid gland with extracapsular extension and vascular invasion, a metastatic follicular thyroid carcinoma to the mandible. The patient received 150 milli-curies dose of radioactive Iodine-131 postoperatively. She is on regular follow up and actually disease free. In conclusion, the clinical presentation of a metastatic lesion to the jaw bone, especially to the mandible, can be challenging to a clinician and a consideration for metastatectomy should be made for a secondary tumor from a thyroid primary, given its potential for a durable symptom and disease control and possibly a favorable long term outcome.