Endocrine Abstracts

Neuroendocrine tumours (NETs) are rare malignancies often presenting with non-specific symptoms, delaying diagnosis[1]. Most are detected at advanced stages, commonly metastasising to the liver, bone, and lymph nodes[2]. Metastasis to the head and neck, particularly the mandible, is exceedingly uncommon[3]. We present a rare case of metastatic pulmonary NET initially manifesting as dental pain, highlighting the diagnostic challenges and importance of multidisciplinary evaluation in such atypical presentations. A 71-year-old man with a previous history of thyroid and prostate cancer presented with persistent left lower third molar pain. Dental radiography revealed a radiolucent lesion surrounding the tooth and involving the inferior alveolar nerve. During extraction, the mandibular bone appeared moth-eaten, raising suspicion of malignancy. Histopathology demonstrated malignant cells positive for CK7, CK20, CK19 (~35%), synaptophysin, and CD56, consistent with a neuroendocrine phenotype, and negative for markers including Melan-A, TTF-1, PAX8, and PSA, suggesting a third primary malignancy. CT and DOTATATE PET imaging revealed widespread metastases in the lungs, liver, and bone. Biopsy of a liver lesion confirmed a large-cell neuroendocrine carcinoma (Ki-67 40%) with focal TTF-1 positivity, indicating a pulmonary origin[4]. The patient commenced carboplatin–etoposide chemotherapy and received palliative radiotherapy to the bone lesions. This case demonstrates a rare presentation of metastatic pulmonary NET with mandibular involvement, mimicking odontogenic pathology[3,5]. Such cases emphasise the need for early biopsy when clinical or radiographic features are atypical. Multidisciplinary input was crucial in diagnosis and management. In patients with known malignancy or unexplained oral symptoms, metastasis should be considered early. Mandibular metastasis from a pulmonary NET is extremely rare and can mimic benign dental disease. Prompt recognition, histological confirmation, and coordinated MDT care are essential for optimal management of such atypical cases.

References:

1. DOI: 10.1016/j.neo.2017.09.002

2. DOI: 10.1200/JCO.2007.15.4377

3. DOI: 10.1111/j.1600-0714.1994.tb00072.x

4. DOI: 10.1097/JTO.0000000000000092

5. DOI: 10.1002/hed.27041