A case of central carcinoma of the mandible diagnosed clinically as chronic osteomyelitis

The subject (female, 63 years old) had been under oral administration of steroids for glaucoma for 5 years. She came to our hospital with the chief complaint of numbness in the right lower lip. Panorama X-P upon the first consultation revealed no bilateral differences in the mandible. Other than generally distributed osteoporotic change, the screening examination revealed no abnormalities such as malignancy-induced bone destruction. Accordingly, we initiated treatment suspecting atypical chronic mandibular myelitis induced by steroid administration. Since the symptom was not relieved, a biopsy was taken to check for neoplastic disease. Pathohistological examination indicated squamous cell carcinoma. Close examination after admission disclosed multiple carcinomatous foci in the lungs and liver. Since surgical treatment was judged inapplicable, the subject was given chemotherapy. However her condition further worsened. Although there were no abnormal findings in the gingival mucosa, a swelling in the right mandible extended itself to the opposite side. Moreover, bleeding began from the gingival margin of the remaining teeth. The subject died 7 months after the first consultation. This was a case of a patient under steroid administration complicated by osteoporosis and primary cancer of the mandible. These complications made a correct diagnosis difficult. We keenly recognize the difficulty of differential diagnosis between inflammatory diseases and malignant neoplastic diseases under such conditions.