Synovial sarcoma metastatic to the mandible: report of two cases.

Abstract While tumor metastasis to the mandible is considered rare, its true incidence probably is underreported for several reasons. First, the historical rarity of this manifestation of malignancy may result in a lowered index of suspicion on the part of clinicians; radiographic and radionuclide bone surveys done during metastatic workups seldom include separate views of the jaws. Second, asymptomatic or mildly symptomatic lesions may be overlooked in cancer patients, or may be thought to be odontogenic or benign in nature. Finally, patients may die before jaw metastases become apparent, and postmortem examinations rarely include the mandible. The discovery of metastasis may signal a change in prognosis that can affect both oncologic treatment planning and patient management. A mandibular lesion may provide the first indication that a known primary cancer has spread or that generalized metastatic disease is progressing. It can indeed be the very first sign of an occult malignancy. Metastasis is one of the major causes of treatment failure in clinical oncology. 1 For these reasons, the importance of careful clinical and radiographic investigation of apparent dental aberrations in cancer patients cannot be overstated. The following report describes, in two patients, the metastasis of a very rare soft-tissue sarcoma to the mandible, and its presentation, diagnosis, clinical course, and outcome.