wkw Unilateral face swelling as first manifestation of metastatic pancreatic cancer 21–22/2008 case report 693 Wien Klin Wochenschr (2008) 120: 693–696 DOI 10.1007/s00508-008-1084-4 Printed in Austria © Springer-Verlag 2008 Wiener klinische Wochenschrift The Middle European Journal of Medicine Unilateral face swelling as first manifestation of metastatic pancreatic cancer: Case report and review of the literature Laurenz Vormittag 1 , Boban Erovic 2 , Christian Schopper 3 , Christoph C. Zielinski 1 , Gabriela Kornek 1 , Dietmar Thurnher 2 1 Department of Internal Medicine I and Cancer Center, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria 2 Department Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria 3 Department of Cranio- Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria Received April 14, 2008, accepted after revision September 25, 2008 Einseitige Gesichtsschwellung als Erstsymptom eines metastasierten Pankreaskarzinoms – Fallbericht und Übersicht über die Literatur Zusammenfassung. Hintergrund: Metastatische Ab- siedlungen in den Kiefer-, Gesichtsbereich sind bei Pati- enten mit Pankreaskarzinom ungewöhlich und bislang erst in fünf Fällen beschrieben worden. Fallbericht: Ein 54-jähriger männlicher Patient suchte das Krankenhaus wegen einer Schwellung im Bereich des Unterkiefers auf. Histologisch bestand ein Adenokarzinom. Eine Computertomographie führte schließlich zur Diagnose eines Pankreaskarzinoms. Eine Radiochemotherapie wurde eingeleitet, jedoch frühzeitig aufgrund von intraoralen Blutungen im Be- reich der Metastase wieder abgebrochen. In der Folge erhielt der Patient palliative Chemotherapie. Das Pri- mum konnte stabilisiert werden, wohingegen die Raum- forderung im Bereich der Mandibula weiter an Größe zunahm. Trotz maximaler Supportivtherapie verstarb der Patient im Januar 2007. Schlussfolgerung: Bei einer für Metastasen unge- wöhnlichen Lokalisation wie der Mandibula sollte nicht nur Frage eines potentiell kurativen Therapieansatzes, sondern auch die möglicherweise geringere Sensitivität gegenüber konservativer Therapie und die Lebensquali- tät des Patienten in die Entscheidung, ob eine Metasta- senresektion durchgeführt wird, miteinfließen. Summary. Objective: Metastasis to the jaw is a rare find- ing in pancreatic cancer; only five cases of tumor spread to the oral region have been described. Case report: We report on a previously healthy 54-year-old man who attended the hospital in 2006 be- cause of a mandibular mass. Histology was positive for adenocarcinoma and computed tomography led to the diagnosis of pancreatic cancer. Chemoradiotherapy was started but had to be stopped early because of intraoral bleeding from the metastasis. The patient subsequently received palliative chemotherapy. The primary cancer was stabilized but the mandibular mass progressed de- spite cytostatic therapy. Despite best supportive mea- sures the patient died nine months after presentation. Conclusion: In making the decision on whether me- tastasectomy should be performed in an uncommon site of metastatic spread such as the mandibula, both the possibility of cure and also the potentially decreased response to conservative therapy and the patient’s de- creased quality of life have to be considered. Key words: Pancreatic cancer, metastasis to the man- dibula, unilateral face swelling, initial symptom. Introduction Approximately 1% of all malignant tumors in the oral cavity are of metastatic origin and in the majority of cases widespread malignancy is present [1]. Metastases to the jaw most frequently originate from breast and lung cancer [2, 3]. In the present case study we report on a patient in whom the first sign of pancreatic cancer was a mass in the jaw. Case report In April 2006 a previously healthy 54-year-old man at- tended the department of maxillofacial surgery at the medical university of Vienna with a painful swelling of the left submandibular region, where a traumatic injury Correspondence: Dietmar Thurnher, MD, Department Otorhino- laryngology, Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria, E-mail: dietmar.thurnher@meduniwien.ac.at