Pezzuto Aldo, Morrone Michelangelo, Mici Elidon
Department of Cardiopulmonary and Vascular Science, Sant'Andrea Hospital-Sapienza University Rome, PhD Medical Bio-Science Campus Unit of Physical and Rehabilitation Medicine, Department of Medicine, Campus Bio-Medico University Maxillo-facial Unit, Surgery Department, S. Andrea Hospital-Sapienza University, Rome, Italy.
Medicine (Baltimore). 2017 May;96(21):e6987. doi: 10.1097/MD.0000000000006987.
Jaw metastasis is a very rare condition associated with lung cancer evolution. In this paper we present two cases of patients who underwent different approach.Lung cancer is the leading cause of cancer related death worldwide. Survival depends on the staging and biology of tumor. Smoking may affect the prognosis.
There are herein reported the cases of two patients affected by squamous cell lung cancer with spread to mandibular bone.
In the first case a computed tomography (CT scan) showed a large mass located in upper right lung , then bronchoscopy was performed with biopsies and the histology revealed a squamous cell carcinoma P63+ and TTF-. In the second case upper right lung mass with metastases to mediastinal bilateral lymph nodes was found at CT scan. A bronchial biopsy revealed a squamous cell carcinoma p63 positive and TTF-1 negative.
The first, a 65-years old man, current heavy smoker who quit and relapsed, at initial stage of IIa (T2aN1M0), after initial neo-adjuvant chemotherapy underwent lung lobectomy and lymph nodes resection. Three months later a metastasis located on mandibular bone was found out. The second case, a 68-years old female heavy smoker, at initial stage IIIb not available for surgery because of involvement of bilateral lymph nodes, underwent first line course chemotherapy with cisplatin and vinorelbine and second line with erlotinib.
The first patient underwent hyperthermia and radiotherapy but a sepsis developed and patients died. In the second case, after two months from the beginning of II line the patient developed a jaw metastasis and underwent surgery with resection of hemi-mandible, but soon after she died because of pulmonary embolism.
These cases highlight the poor prognosis of patients current smokers affected by squamous cell lung cancer. The jaw bone localization is very rare and different approach could be applied.
颌骨转移是一种与肺癌进展相关的非常罕见的情况。在本文中，我们介绍了两例接受不同治疗方法的患者。肺癌是全球癌症相关死亡的主要原因。生存率取决于肿瘤的分期和生物学特性。吸烟可能影响预后。
本文报告了两例鳞状细胞肺癌扩散至下颌骨的患者病例。
第一例患者，计算机断层扫描（CT扫描）显示右上肺有一个大肿块，随后进行了支气管镜检查及活检，组织学检查显示为P63+和TTF-的鳞状细胞癌。第二例患者，CT扫描发现右上肺肿块伴有双侧纵隔淋巴结转移。支气管活检显示为p63阳性和TTF-1阴性的鳞状细胞癌。
第一例患者为一名65岁男性，目前重度吸烟者，戒烟后复吸，处于IIa期（T2aN1M0）初始阶段，在初始新辅助化疗后接受了肺叶切除术和淋巴结切除术。三个月后发现下颌骨转移。第二例患者为一名68岁女性重度吸烟者，处于IIIb期初始阶段，因双侧淋巴结受累无法进行手术，接受了顺铂和长春瑞滨的一线化疗疗程以及厄洛替尼的二线化疗。
第一例患者接受了热疗和放疗，但发生了败血症，患者死亡。第二例患者，在二线治疗开始两个月后出现颌骨转移，接受了半侧下颌骨切除术，但不久后因肺栓塞死亡。
这些病例突出了目前吸烟的鳞状细胞肺癌患者预后较差。颌骨转移非常罕见，可以采用不同的治疗方法。
