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Lung Cancer |

Temporomandibular Joint Dysfunction Syndrome: A Rare Initial Presentation of Adenocarcinoma of the Lung

Narjust Duma, MD; Marcus Sandling, MD; Larysa Sanchez, MD; Mohleen Kang, MD
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Rutgers-New Jersey Medical School, Newark, NJ


Chest. 2015;148(4_MeetingAbstracts):577A. doi:10.1378/chest.2264571
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Abstract

SESSION TITLE: Lung Cancer Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Lung cancer can have diverse and sometimes dramatic initial presentations. We present a case of a patient who was previously diagnosed with temporomandibular joint dysfunction (TMJ) syndrome and later shown to be secondary to an undiagnosed metastatic adenocarcinoma of the lung.

CASE PRESENTATION: A 50 year old female with past medical history of hypertension and a 30 pack-year smoking history presented with right jaw pain starting at the mandible and radiating to the right frontal area for 8 months. The pain had progressively worsened and in the past 4 months was accompanied of migraines and unsteady gait. The patient was diagnosed by her dentist with TMJ syndrome and had undergone several dental procedures. Her symptoms continued to worsen and she was referred for a brain MRI which revealed multifocal infratentorial and supratentorial mass lesions, with a dominant mass in the right frontal lobe measuring 5.6 cm with associated vasogenic edema and a right to left midline shift. Patient was admitted for further work up and search of the primary malignancy. A chest X-ray revealed a suprahilar mass measuring 3.6x2.8 cm. Follow up chest CT reported a right suprahilar irregular mass, 4.1 cm in axial diameter with extensive invasion of hilar and precarinal lymph nodes. Right fronto-temporal craniotomy was performed with subtotal resection of the frontal lobe metastasis. The patient tolerated the procedure well with no major neurological deficits post-operatively. Pathology reported a moderately differentiated adenocarcinoma with focal papillary features consistent with metastatic adenocarcinoma of the lung. The patient was discharged with plans for outpatient chemotherapy.

DISCUSSION: Lung cancer is a common cause of central nervous system metastasis, these patients usually present with seizures or focal neurologic deficits that are directly associated with the anatomic location of the metastasis [1]. On review of literature, only 48 cases of TMJ syndrome as the initial presentation of a neoplasm have been reported in the English literature. Of these, breast cancer was the most common primary malignancy (34%), followed by lung cancer (21%) with adenocarcinoma being the most common histologic subtype (73%) [2].

CONCLUSIONS: This case illustrates the importance of considering malignancy in the differential diagnosis especially when the initial presenting symptoms do not resolve with appropriate treatment.

Reference #1: Gavrilovic IT, Posner JB. Brain metastases: epidemiology and pathophysiology. J Neurooncol 2005; 75:5.

Reference #2: Kruse, Astrid LD, et al. "Temporomandibular disorders associated with metastases to the temporomandibular joint: a review of the literature. Oral Surgery 110.2 (2010): e21-e28.

DISCLOSURE: The following authors have nothing to disclose: Narjust Duma, Marcus Sandling, Larysa Sanchez, Mohleen Kang

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