Metastatic pancreatic cancer mimicking medication related osteonecrosis of the jaw—A rare clinical presentation

Abstract

Pancreatic cancer is a highly aggressive malignancy with a poor prognosis owing to its rapid progression, high mortality rate, and alarming 5‐year survival rate of 5%. Skeletal metastases represent an understated site of metastasis in patients with pancreatic cancer, occurring in about 5%–20% of these patients. The clinical presentation of metastasis to the jaws and osteonecrosis of jaw can exhibit similarities, which may lead to an erroneous diagnosis or create a diagnostic dilemma. We present a case of a 62‐year‐old male patient diagnosed with pancreatic adenocarcinoma and a prior history of bisphosphonate administration who displayed symptoms such as jaw pain, numbness, reduced mouth opening, and an extra‐oral swelling involving a recent tooth extraction site, likely due to medication‐related osteonecrosis of the jaw (ONJ). Despite initial conservative treatment, the patient's symptoms persisted, prompting further investigation. Depending on the specific context and clinical scenario, it is crucial to employ a comprehensive approach such as clinical examination, radiographic imaging, histopathological examination and monitoring the progression of symptoms over time for accurate diagnosis and timely management. This article presents a rare case of metastatic pancreatic cancer mimicking medication related ONJ, highlighting the clinical dilemma and challenges encountered when presenting symptoms and signs are ambiguous. While the prognosis for such cases is generally poor, dentists and healthcare providers should remain vigilant regarding potential sites of metastasis in cases of pancreatic adenocarcinoma.