title: Pancreatic adenocarcinoma presenting as mandibular tumor: case report.
abstract: BACKGROUND
  Pancreatic adenocarcinoma metastasizing to the mandible is extremely rare, with only 4 previous cases reported in the literature. Here, we present a patient with a metastatic lesion in the mandible as the initial manifestation of pancreatic adenocarcinoma. We also review the incidence, diagnosis, and management of this rare occurrence.
  
  
  METHODS
  A 45-year-old man with a 5-week history of pain, following a tooth extraction, was referred to our Oral & Maxillofacial Department and presented with a nonhealing socket in the mandibular premolar region. He was investigated by use of imaging and an urgent biopsy. The diagnosis of pancreatic neoplasm was made. At this stage, the disease was fairly extensive and management was palliative.
  
  
  CONCLUSIONS
  This case demonstrates the importance of a full investigation when a patient presents with a nonhealing socket and pain after tooth extraction. Mandibular metastases from distant primaries often have poor prognosis, with most patients getting palliative support. A multidisciplinary team approach is required for the management of these rare cases.
authors.affiliation: Senior House Officer, Department of Oral and Maxillofacial Surgery, Royal Preston Hospital, Lancashire Teaching Hospital Trust, Lancashire, United Kingdom.
authors.forename: Nicola R
authors.initials: NR
authors.lastname: Jaffa
authors.affiliation: Senior House Officer, Department of Oral and Maxillofacial Surgery, Royal Preston Hospital, Lancashire Teaching Hospital Trust, Lancashire, United Kingdom.
authors.forename: Danny
authors.initials: D
authors.lastname: Adam
authors.affiliation: Consultant, Department of Oral and Maxillofacial Surgery, Royal Preston Hospital, Lancashire Teaching Hospital Trust, Lancashire, United Kingdom.
authors.forename: Shakeel
authors.initials: S
authors.lastname: Akhtar
authors.affiliation: Specialty Registrar, Department of Oral and Maxillofacial Surgery, Royal Preston Hospital, Lancashire Teaching Hospital Trust, Lancashire, United Kingdom. Electronic address: kyzasp@me.com.
authors.forename: Panayiotis A
authors.initials: PA
authors.lastname: Kyzas
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis*