顎下リンパ節腫大を契機に発見された下顎骨原発性骨内扁平上皮癌例

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A 54-year-old man, seen for right submandibular swelling and pain, noted swelling enlargement and lymph node swelling in his right neck within a week. These were found in fine-needle aspiration biopsy to be lymph node metastases of squamous cell carcinoma. FDG-PET showed high accumulation on the right side of the mandible bone and in the right neck. Lower gingiva showed mild mucosal inflammation with a transparent mandible bone lesion, so the right lower molar was removed by a dentist, showing a tumor in the mandible bone socket. Biopsy of the lesion showed a squamous cell carcinoma arising centrally in the mandible bone. A diagnosis of primary intraosseous squamous cell carcinoma (PIOSCC) necessitated mandibular resection, neck dissection, and postoperative radiochemotherapy. Within 10 months, lung metastasis was seen. He died of multiple organ metastases, despite subsequent surgery, radiotherapy, and chemotherapy. PIOSCC generally has a dismal prognosis because symptoms are not noticed until the disease has progressed beyond treatment.