Fine needle aspiration biopsy of mandible: an effective alternative to conventional biopsy for the differential diagnosis between metastasis and osteonecrosis in oncologic patients treated with bisphosphates - Case report
DOI:
https://doi.org/10.5935/2525-5711.20170024Keywords:
Biopsy, Fine-Needle, Breast Neoplasms, Neoplasm Metastasis, Bisphosphonate-Associated Osteonecrosis of the JawAbstract
Bisphosphonates are the drugs of choice for the prevention and treatment of bone metastases of breast cancer, especially in more advanced cases. Osteonecrosis of the jaw (BRONJ) is the most common, debilitating complication of the use of this drug, caused mainly by bone manipulation. Because of this, the indication for biopsy for differential diagnosis is critical in cases of radiographic findings without mandibular exposure, and less invasive diagnostic methods have been discussed in the literature. The objective of this study was to describe a case of differential diagnosis of mandibular metastasis of breast cancer and BRONJ by fine needle aspiration (FNA). A 67-year-old woman was referred to the Dentistry and Stomatology Service of Ribeirao Preto General Hospital, Brazil, in January 2015, for investigation of pain followed by paresthesia in the lower lip. The patient had a history of mixed breast carcinoma in 1999, recurrent in 2010, treated with chemotherapy and Zometa from 2010 to 2013. Although no significant alterations were detected at clinical examination, the CT scan revealed osteolytic lesions involving the anterior and posterior right jaw. Because of the risk of bone necrosis after biopsy, FNA was chosen as the diagnostic method. Cytology confirmed metastasis of breast cancer and the patient had no complications in the puncture area. FNA was shown to be a viable, safe option for differential diagnosis between BRONJ and mandibular bone metastasis.
References
Moura VPT, Fonseca SM, Gutiérrez MGR. Cuidando de paciente com câncer de mama e osteonecrose mandibular induzida por bisfostonato: relato de experiência. Acta Paul Enferm. 2009;22:89-92.
Hwang YS, Han SS, Kim KR, Lee YJ, Lee SK, Park KK, et al. Validating of the pre-clinical mouse model for metastatic breast cancer to the mandible. J Appl Oral Sci. 2015;23:3-8.
Neville BW, Damm DD, Allen CM, Bouquot JE. Patologia oral e maxilofacial. 3ª ed. Rio de Janeiro: Elsevier; 2009. p. 671-2.
Vasconcellos DV, Maia RC, Duarte MEL. Efeito anti-tumoral dos bisfosfonatos: uma nova perspectiva terapêutica. Rev Bras Cancerol. 2004;50(1):45-54.
Carlson ER, Schlott BJ. Anti-resorptive osteonecrosis of the jaws: facts forgotten, questions answered, lessons learned. Oral Maxillofac Surg Clin North Am. 2014;26:171-91.
Gabbert TI, Hoffmeister B, Felsenberg D. Risk factors influencing the duration of treatment with bisphosphonates until occurrence of an osteonecrosis of the jaw in 963 cancer patients. J Cancer Res Clin Oncol. 2015;141:749-58.
Farrugia MC, Summerlin DJ, Krowiak E, Huntley T, Freeman S, Borrowdale R, Tomich C. Osteonecrosis of the mandible or maxilla associated with the use of new generation bisphosphonates. Laryngoscope. 2006;116:115-20.
Jadu F, Lee L, Pharoah M, Reece D, Wang L. A retrospective study assessing the incidence, risk factors and comorbidities of pamidronate-related necrosis of the jaws in multiple myeloma patients. Ann Oncol. 2007;18:2015-9.
Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, et al.; International Task Force on Osteonecrosis of the Jaw. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015;30:3-23.
Ruggiero SL, Fantasia J, Carlson E. Bisphosphonate-related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:433-41.
Reid-Nicholson M, Teague D, White B, Ramalingam P, Abdelsayed R. Fine needle aspiration findings in malignant ameloblastoma: a case report and differential diagnosis. Diagn Cytopathol. 2009;37:586-91.
Hirshberg A, Shnaiderman-Shapiro A, Kaplan I, Berger R. Metastatic tumours to the oral cavity - pathogenesis and analysis of 673 cases. Oral Oncol. 2008;44:743-52.
Jain S, Kadian M, Khandelwal R, Agarwal U, Bhowmik KT. Buccal metastasis in a case of carcinoma breast: A rare case report with review of literature. Int J Surg Case Rep. 2013;4:406-8.
Fliefel R, Tröltzsch M, Kühnisch J, Ehrenfeld M, Otto S. Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review. Int J Oral Maxillofac Surg. 2015;44:568-85.
Holmes FA, Buzdar AU, Kau SW, Fraschini G, Ames FC, McNeese MD, et al. Combined-modality approach for patients with isolated recurrences of breast cancer (IV-NED). The M. D. Anderson experience. Breast Dis. 1994;7:7-20.
Goyal S1, Sharma S, Kotru M, Gupta N. Role of FNAC in the diagnosis of intraosseous jaw lesions. Med Oral Patol Oral Cir Bucal. 2015;20:e284-91.
