Breast Cancer Metastasis to Mandibular Condyle Identified on TMJ Evaluation

A 62-year-old female with a history of breast cancer treated with chemotherapy and radiation nine years prior was referred for evaluation of sudden pain in the pre-auricular area and an unspecified sensory deficit in the right mandible. Upon review, the radiologist identified irregular changes of the right condylar head and neck with periosteal reaction, severe sclerosis, and erosive changes. Notably, the right mandibular foramen had an erosive appearance with loss of definition and an obliterated lingula. The radiologist alerted the clinician that the appearance was highly suspicious for breast cancer metastasis. The patient returned to her oncologist and breast cancer metastasis to the mandible was confirmed. Two years later, a follow-up scan was submitted in which the radiologist identified a suspected new breast cancer lesion in the C4 vertebra that was not present on the initial scan. This case demonstrates the importance of radiologist review in identifying metastatic disease in patients with a history of malignancy, even years after treatment, and how follow-up imaging can reveal new sites of disease that may alter the oncologic treatment approach.