Mason A Corde, Azari Kodi K, Farkas Linda M, Duvvuri Umamaheswar, Myers Eugene N
Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Head Neck. 2005 Aug;27(8):729-32. doi: 10.1002/hed.20224.
Metastatic adenocarcinoma of the colon is a frequently encountered medical situation. Metastasis to the mandible from adenocarcinoma of the colon is very unusual and rarely reported. We report the case of a 73-year-old man with metastatic adenocarcinoma to the mandible.
The patient was referred for evaluation of a mass of 2 months' duration in the right parotid gland. He gave a history of watery bowel movements of unknown duration. Physical examination revealed a 7- x 6-cm hard mass, which seemed to be fixed to the right mandible. A CT scan revealed a destructive process involving the ramus and condyle of the right mandible that invaded the pterygopalatine fossa, pterygoid muscles, and middle cranial fossa. CT scans of the abdomen and pelvis revealed a 5-cm mass in the sigmoid colon with metastases to the liver.
A biopsy of the mass in the mandible was performed, and metastatic adenocarcinoma of colonic origin was diagnosed. Colonoscopy and biopsy of the colonic mass substantiated that the sigmoid colon was the primary site of the cancer. Because the patient had disseminated disease, he declined treatment, and he died shortly thereafter.
Although rare, metastatic adenocarcinoma from the colon to the mandible and parotid area should be included in the differential diagnosis of masses in this area. After analysis of our case and a review of the literature, we conclude that metastasis from adenocarcinoma of the colon is quite rare and represents incurable disseminated disease.
结肠转移性腺癌是一种常见的临床情况。结肠腺癌转移至下颌骨非常罕见，鲜有报道。我们报告一例73岁男性下颌骨转移性腺癌病例。
患者因右侧腮腺区持续2个月的肿物前来评估。他有持续时间不明的水样便病史。体格检查发现一个7×6厘米的硬块，似乎与右侧下颌骨相连。CT扫描显示右侧下颌骨升支和髁突有破坏过程，侵犯了翼腭窝、翼状肌和中颅窝。腹部和盆腔CT扫描显示乙状结肠有一个5厘米的肿物，并伴有肝转移。
对下颌骨肿物进行活检，诊断为结肠源性转移性腺癌。结肠镜检查及结肠肿物活检证实乙状结肠为癌的原发部位。由于患者已有播散性疾病，他拒绝治疗，此后不久死亡。
尽管罕见，但结肠至下颌骨和腮腺区的转移性腺癌应列入该区域肿物的鉴别诊断中。在分析我们的病例并复习文献后，我们得出结论，结肠腺癌转移相当罕见，代表不可治愈的播散性疾病。
