Suspected Metastatic Lesion Identified in Patient with Known Malignancies

A 70-year-old male with depression, HIV, and malignant tumors of the colon and prostate was referred by a general dentist planning all-on-x procedures. The radiologist identified several periapical inflammatory lesions and lesions of cemento-osseous dysplasia. However, an additional poorly defined intra-osseous low-density lesion was noted in an edentulous site. While this could represent a residual inflammatory lesion or cemento-osseous dysplasia, the radiologist noted that an aggressive lesion of non-inflammatory etiology, specifically metastatic disease, needs to be ruled out given the patient's history of colon and prostate malignancy. The radiologist noted that this type of finding may be easily overlooked when several other inflammatory lesions are present, since malignant and inflammatory lesions share radiographic features, and that the prevalence of malignancy and metastasis is increased in older patients with HIV.