METASTASIS AROUND DENTAL IMPLANTS MASCARAING AS PERI-IMPLANTITIS - A WOLF IN SHEEP'S CLOTHING

Background Placement of dental implants is a common procedure with a high success rate. A minority of the cases fail, however, a manifestation termed peri-implantitis, which is considered clinically obvious, hence often not biopsied. Case report In this report, a case of metastatic lung adenocarcinoma mimicking peri-implantitis adjacent two dental implants is presented. The lesion occurred eight months after the surgical implantation procedure and by that time, the underlying malignancy was unknown to the patient. During the surgical procedure itself’, and even in the follow up meetings, there was no apparent clinical or radiographic sign of a metastatic disease, but during an eight months follow up session, the soft tissue around the implants was firmly swelled and mildly erythematous, and the x ray imaging revealed a nonspecific ill-defined radiolucency of the alveolar bone. The tissue was excised, adjacent bone was curated and the tissue was submitted to histopathological analysis. The pathological picture presented a malignant tumor composed of epithelial islands embedded within a fibrous stroma. The epithelial islands presented atypical features and an immunohistochemical phenotype of lung adenocarcinoma that included positive pan keratin, thyroid transcription factor-1 and napsin-A and negative thyroglobulin and prostatic specific antigen. Concurrently, the patient was diagnosed with a lung adenocarcinoma and started systemic treatment. Conclusion This case of metastatic disease masquerading as peri-implantitis reflects the importance of submitting any tissue to histopathological assessment.