1
|
Zhu GG, Lu C, Petrovic I, Nafa K, Chen W, Syed A, Rana S, Klein MJ, Huang S, Wang L, Tap WD, Ghossein RA, Shah J, Hameed MR. DNA Mutational and Copy Number Variation Profiling of Primary Craniofacial Osteosarcomas by Next-Generation Sequencing. Head Neck Pathol 2024; 18:48. [PMID: 38884816 PMCID: PMC11183031 DOI: 10.1007/s12105-024-01634-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/26/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Craniofacial osteosarcomas (CFOS) are uncommon malignant neoplasms of the head and neck with different clinical presentation, biological behavior and prognosis from conventional osteosarcomas of long bones. Very limited genetic data have been published on CFOS. METHODS In the current study, we performed comprehensive genomic studies in 15 cases of high-grade CFOS by SNP array and targeted next generation sequencing. RESULT Our study shows high-grade CFOS demonstrate highly complex and heterogenous genomic alterations and harbor frequently mutated tumor suppressor genes TP53, CDKN2A/B, and PTEN, similar to conventional osteosarcomas. Potentially actionable gene amplifications involving CCNE1, AKT2, MET, NTRK1, PDGFRA, KDR, KIT, MAP3K14, FGFR1, and AURKA were seen in 43% of cases. GNAS hotspot activating mutations were also identified in a subset of CFOS cases, with one case representing malignant transformation from fibrous dysplasia, suggesting a role for GNAS mutation in the development of CFOS. CONCLUSION High-grade CFOS demonstrate highly complex and heterogenous genomic alterations, with amplification involving receptor tyrosine kinase genes, and frequent mutations involving tumor suppressor genes.
Collapse
Affiliation(s)
- Gord Guo Zhu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Pathology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Chuanyong Lu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Ivana Petrovic
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Khedoudja Nafa
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Wen Chen
- Department of Pathology, Washington DC VA Medical Center, Washington, DC, 20310, USA
| | - Aijazuddin Syed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Satshil Rana
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Michael J Klein
- Department of Pathology, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Sinchun Huang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Lu Wang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, 38103, USA
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Jatin Shah
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Meera R Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| |
Collapse
|
2
|
Indermun S, Titinchi F, Alwan J, Morkel J, Nortje CJ. Osteosarcoma associated with cemento-osseous dysplasia: co-incidence or two related entities? Oral Radiol 2024:10.1007/s11282-024-00758-2. [PMID: 38852116 DOI: 10.1007/s11282-024-00758-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Osteosarcoma of the jaws is a rare primary malignant tumor of bone. The clinical, radiological and histopathological features of a case associated with cemento-osseous dysplasia is presented. CASE REPORT A 57-year-old mixed-race female presented with a large, progressive, swelling of the right mandible. Radiographic examination revealed two associated lesions. Partially defined irregular radiopacities were noted in the left mandible, extending from the premolar to the molar region. The lesion had a cotton-wool appearance and resembled a fibro-osseous lesion; i.e. cemento-osseous dysplasia. A second large, expansive and irregular, radiopaque lesion was noted on the right angle of the mandible, extending beyond the inferior cortex of the mandible. The internal structure was heterogeneous and resembled irregular bone formation. The classic "sunburst" appearance of radiating bony spicules can be seen in the posterior-anterior view and the CBCT 3D reconstruction, indicating the outgrowth of the tumor matrix. Histopathological exam confirmed a final diagnosis of osteosarcoma closely associated with cemento-osseous dysplasia. The patient underwent a fludeoxyglucose-18 (FDG) positron emission tomography (PET) scan which indicated metastasis in the left lung and increased uptake in the right mandible. Chemotherapy was initially administered with a plan to resect the tumor, however, the patient demised as a result of medical complications. CONCLUSION The question in the literature remains whether these two entities are coincidentally found or arise from each other. Nevertheless, it is important for clinicians to closely monitor patients with cemento-osseous dysplasia and biopsy any suspicious lesions that may develop into osteosarcoma.
Collapse
Affiliation(s)
- Suvarna Indermun
- Department of Craniofacial Biology, Pathology and Radiology, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa.
| | - Fadi Titinchi
- Department of Maxillo-Facial and Oral Surgery, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa
| | - Julandi Alwan
- Department of Craniofacial Biology, Pathology and Radiology, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa
- Department of Anatomical Pathology, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Jean Morkel
- Department of Maxillo-Facial and Oral Surgery, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa
| | - Christoffel Johannes Nortje
- Department of Craniofacial Biology, Pathology and Radiology, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
3
|
Muylaert F, De Kock L, Creytens D, Verstraete K, Coopman R. High-grade osteosarcoma arising in DCIA flap reconstruction after a prior resection of maxillar cemento-ossifying fibroma: A case report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101591. [PMID: 37558180 DOI: 10.1016/j.jormas.2023.101591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
Cemento-ossifying fibroma is a rare benign odontogenic tumour of the tooth-bearing jaws. Its concomitant occurrence with osteosarcoma, a malignant maxillofacial bone tumour, has never been described before. We present an uncommon case of a 43-year-old woman in whom a cemento-ossifying fibroma in the right maxilla was treated by resection and reconstruction using a deep circumflex iliac artery flap. During surgical prosthetic rehabilitation one-year post-operative, an osteosarcoma extending from the contralateral maxilla was coincidentally discovered in the deep circumflex iliac artery flap. The aim of this case report is to raise awareness on the extremely rare but possible simultaneous and independent occurrence of a cemento-ossifying fibroma and an osteosarcoma.
Collapse
Affiliation(s)
- Frances Muylaert
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Lisa De Kock
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Koenraad Verstraete
- Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium; Head of Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Renaat Coopman
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| |
Collapse
|
4
|
Liu Y, Housley Smith M, Patel PB, Bilodeau EA. Pediatric Gnathic Bony and Mesenchymal Tumors. Pediatr Dev Pathol 2023; 26:621-641. [PMID: 37232383 DOI: 10.1177/10935266231170744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Evaluation of bone pathology within the head and neck region, particularly the gnathic bonesis is complex, demonstrating unique pathologic processes. In part, this variation is due to odontogenesis and the embryological cells that may be involved, which can contribute to disease development and histologic variability. As with any boney pathosis, the key is to have clinical correlation, particularly with radiographic imaging prior to establishing a definitive diagnosis. This review will cover those entities that have a predilection for the pediatric population, and while it is not all inclusive, it should serve as a foundation for the pathologist who is evaluating bony lesions involving the craniofacial skeleton.
Collapse
Affiliation(s)
- Yingci Liu
- Rutgers School of Dental Medicine, Newark, NJ, USA
| | | | - Paras B Patel
- Center for Oral Pathology, Dallas, TX, USA
- Oral and Maxillofacial Pathology ProPath, Dallas, TX, USA
| | - Elizabeth Ann Bilodeau
- Oral & Maxillofacial Pathology, Director, UDHS Oral Pathology Laboratory, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| |
Collapse
|
5
|
Nedelec M, Pouget C, Etienne S, Brix M. Juvenile trabecular ossifying fibroma: A case of extensive lesion of the maxilla. Int J Surg Case Rep 2023; 111:108620. [PMID: 37703694 PMCID: PMC10502336 DOI: 10.1016/j.ijscr.2023.108620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Juvenile trabecular ossifying fibroma is a rare benign tumor of childhood affecting the facial bones rarely described in literature. Its aggressive growth and high tendency of recurrence make it a real challenge for diagnosis and care. CASE PRESENTATION This article presents a case of an extensive juvenile trabecular ossifying fibroma of the maxilla in a 14-year-old boy, which required surgical intervention with immediate bone reconstruction using an autogenous graft (iliac crest). No recurrence has been found after two and a half years of follow-up. CLINICAL DISCUSSION Common symptoms of juvenile trabecular ossifying fibroma include painless swelling, facial asymmetry, jaw deformity and teeth displacement. Differential diagnosis should consider other forms like psammomatoid ossifying fibroma, osteofibrous dysplasia, fibrous dysplasia, ameloblastoma, odontoma, or even poorly differentiated carcinoma. CONCLUSION Currently, there is no recommendation or consensus for the treatment of juvenile trabecular ossifying fibroma. The objective of treatment is also to preserve growth and development and conserve the nervous structure and the function, as mastication, vision. Early diagnosis and appropriate care are essential to prevent morphological and functional defects in young patients. Regular and long-term follow-up is essential due to the high recurrence rate.
Collapse
Affiliation(s)
| | - Celso Pouget
- Dept of anatomopathology, University Hospital, Nancy, France
| | - Simon Etienne
- Medical Professor Dept. of Oral and Maxillofacial Surgery, and plastic surgery, University Hospital, Nancy, France
| | - Muriel Brix
- Medical Professor Dept. of Oral and Maxillofacial Surgery and plastic surgery, university hospital, Nancy, France
| |
Collapse
|
6
|
Bahceci DH, Grenert JP, Jordan RCK, Horvai AE. Genomic Profiling of the Craniofacial Ossifying Fibroma by Next-Generation Sequencing. Head Neck Pathol 2023; 17:722-730. [PMID: 36928741 PMCID: PMC10513971 DOI: 10.1007/s12105-022-01523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/27/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Ossifying fibroma (OF) of the craniofacial skeleton is a fibro-osseous lesion characterized by various patterns of bone formation in a cellular fibroblastic stroma. The molecular landscape of OF remains mostly unknown. There are a few known pathogenic abnormalities in OF, including HRPT2 mutations in conventional OF and SATB2 translocations in juvenile psammomatoid OF. On the other hand, conflicting reports exist regarding MDM2 gene amplification and chromosomal copy number alterations (CNA) in OF. METHODS Surgically removed biopsies and curettage specimens from OF patients were obtained. Clinical, radiographic, and pathologic features of tumors were reviewed. Genomic DNA was extracted from formalin-fixed, paraffin-embedded blocks of tumor tissue. Capture-based DNA next-generation sequencing targeting the coding regions 529 cancer genes and select introns was performed. RESULTS We identified 17 OF cases from 8 male and 8 female patients with mean age of 22 years (range 1-58 years). Nine case occurred in the gnathic bones and 8 in the extragnathic craniofacial bones. These cases included 3 juvenile psammomatoid OF, 6 conventional OF and 8 juvenile trabecular OF. Large-scale CNAs were present in 6 of 17 cases. Seven cases (41%) had focal amplifications including FOSB (n = 2, 11%), FOS (n = 4, 23%), COL1A1 (n = 4, 23%) and TBX3 (n = 5, 29%). Three cases (17%) had pathogenic CDC73 mutations. No cases showed focal MDM2 amplification. CONCLUSIONS Here, we provided a comprehensive molecular characterization of OF that reveals a heterogeneous genetic profile with occasional large-scale CNAs (n = 6, 35%). FOS, FOSB, and TBX3 genes that regulate AP-1 transcriptional complex are frequently altered in OF (n = 7, 41%), chiefly in juvenile trabecular OF. These genes encode transcription factors that act as downstream effectors of the MAP kinase signaling pathway. MDM2 amplification is an exceedingly rare event in OF, if present at all, so identification of this event should continue to raise concern for low-grade gnathic osteosarcoma. In summary, our findings suggest that OF represents a heterogeneous group of tumors at the genetic level but dysregulation of the AP-1 pathway may play a role in pathogenesis of juvenile trabecular OF.
Collapse
Affiliation(s)
- Dorukhan H Bahceci
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA
| | - James P Grenert
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA
| | - Richard C K Jordan
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA
| | - Andrew E Horvai
- Department of Pathology, University of California at San Francisco, 1825 4Th Street, Room M2354, San Francisco, CA, 94158, USA.
| |
Collapse
|
7
|
Haefliger S, Baumhoer D. [The new WHO classification of jaw tumours]. PATHOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00292-023-01195-4. [PMID: 37179260 DOI: 10.1007/s00292-023-01195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 05/15/2023]
Abstract
Maxillofacial tumours cover a broad spectrum of lesions, including neoplasms, hamartomatous changes and developmental disorders. Since the beginning of 2022, a beta version of the 5th edition of the WHO classification for head and neck tumours has been available online, and a print version is expected to be published in mid-2023. From a conceptual point of view, little has been changed compared to the 4th edition; the sort order of lesions is more rigorously arranged according to benign and malignant behaviour and identical tumour types are no longer described redundantly in different chapters depending on their location. The diagnostic criteria are now summarized as "essential" and "desirable", and in addition to the clinical features, imaging is now also incorporated, providing an interdisciplinary approach to the classification. A few new entities are included for the first time. This article gives an overview of the main changes introduced in the new WHO classification with a special emphasis on fibro-osseous lesions of the craniofacial skeleton.
Collapse
Affiliation(s)
- Simon Haefliger
- Knochentumor-Referenzzentrum am Institut für Pathologie, Universitätsspital Basel, Universität Basel, Schönbeinstr. 40, 4031, Basel, Schweiz
| | - Daniel Baumhoer
- Knochentumor-Referenzzentrum am Institut für Pathologie, Universitätsspital Basel, Universität Basel, Schönbeinstr. 40, 4031, Basel, Schweiz.
| |
Collapse
|
8
|
Huang N, Qiu L, Li Y, Li L. Extraosseous cemento-ossifying fibroma beneath the left buccal mucosa: a case report. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2023; 41:110-113. [PMID: 38596949 PMCID: PMC9988454 DOI: 10.7518/hxkq.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/30/2022] [Indexed: 04/11/2024]
Abstract
Cemento-ossifying fibroma (COF) is a benign mesenchymal odontogenic tumor that commonly occurs in the tooth-bearing areas of the maxilla and mandible. This study reports a COF case located under the left buccal mucosa. The classification and differential diagnosis of this COF case were discussed based on the diagnosis and treatment of this case and previous literature.
Collapse
Affiliation(s)
- Nengwen Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ling Qiu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yi Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Longjiang Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| |
Collapse
|
9
|
Ying H, Wang H, Jiang G, Tang H, Li L, Zhang J. Injectable agarose hydrogels and doxorubicin-encapsulated iron-gallic acid nanoparticles for chemodynamic-photothermal synergistic therapy against osteosarcoma. Front Chem 2022; 10:1045612. [PMID: 36385986 PMCID: PMC9663816 DOI: 10.3389/fchem.2022.1045612] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Osteosarcoma is a malignant bone cancer that usually occurs in children and adolescents. Although chemotherapy, radiotherapy and other methods have been used to treat osteosarcoma, these therapeutic regimens fail to cure this disease completely. Herein, doxorubicin-encapsulated iron–gallic acid (FeGA-DOX) nanoparticles (NPs) were fused with agarose hydrogels (AG) for synergistic therapy of osteosarcoma. Under near-infrared laser irradiation, the local temperature of FeGA-DOX NPs was increased. Therefore, tumour cells were killed using photothermal therapy, and AG dissolved to release FeGA-DOX into the cells. Doxorubicin generates hydrogen peroxide, which is then converted to reactive oxygen species (ROS) via FeGA-DOX by the Fenton reaction, inducing tumour cell apoptosis. ROS induced by chemodynamic therapy compensates for the incomplete cure of osteosarcoma cells. The AG-encapsulated NPs could mediate synergistic chemodynamic and photothermal therapy with self-sufficient H2O2, providing a novel therapeutic strategy for osteosarcoma.
Collapse
Affiliation(s)
- Hongliang Ying
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Haitian Wang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guangchuan Jiang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Han Tang
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Lingrui Li
- College of Medicine, Zhengzhou University, Zhengzhou, China
| | - Jinrui Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Jinrui Zhang,
| |
Collapse
|
10
|
Selvam SP, Ramani P, Ramadoss R, Anandapadmanabhan LT, Sundar S. Incessant Role of Fibroblast in Malignant Transformation of Gnathic Fibro-Osseous Lesions? - Should We Rework on Treatment Strategies. Asian Pac J Cancer Prev 2022; 23:2177-2178. [PMID: 35901320 PMCID: PMC9727358 DOI: 10.31557/apjcp.2022.23.7.2177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Indexed: 12/14/2022] Open
|
11
|
Bahceci DH, Jordan RCK, Horvai AE. MDM2 Gene Amplification and Expression of MDM2 and CDK4 are Rare in Ossifying Fibroma of Craniofacial Bones. Head Neck Pathol 2022; 16:991-997. [PMID: 35546651 PMCID: PMC9729456 DOI: 10.1007/s12105-022-01454-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/04/2022] [Indexed: 12/16/2022]
Abstract
Ossifying fibroma of the craniofacial bones is a fibro-osseous lesion characterized by varied patterns of bone formation in a fibroblastic stroma. Ossifying fibroma is a putatively benign lesion with no reports of malignant transformation or metastasis. Differentiation from other fibro-osseous lesions can be challenging necessitating synthesis of clinical, radiological and pathological findings. The molecular pathogenesis of ossifying fibroma is poorly understood but recent studies have reported MDM2 gene amplification and chromosomal copy number changes in a subset of ossifying fibromas. MDM2 amplification in ossifying fibroma, if true, presents a diagnostic problem because this genetic event, at least among craniofacial fibro-osseous lesions, was previously considered specific for low-grade osteosarcoma. In the present study, we investigated the utility of MDM2 and CDK4 immunohistochemistry, and fluorescence in situ hybridization for MDM2 gene amplification, in the diagnosis of 44 craniofacial bone ossifying fibromas. Focal MDM2 and CDK4 nuclear immunoreactivity was found in 11 and 1 ossifying fibromas, respectively, but none demonstrated MDM2 amplification by fluorescence in situ hybridization. A single tumor displayed MDM2 amplification without nuclear immunoreactivity to either MDM2 or CDK4. Our data suggest that while focal MDM2 and CDK4 nuclear expression may be detected in a minority of ossifying fibromas, this expression does not correlate with MDM2 amplification. In addition, MDM2 amplification is extremely rare in ossifying fibroma so the detection of this genetic abnormality should continue to raise concern for osteosarcoma.
Collapse
Affiliation(s)
- Dorukhan H Bahceci
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA
| | - Richard C K Jordan
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA
| | - Andrew E Horvai
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA.
| |
Collapse
|
12
|
Chronic Osteomyelitis With Proliferative Periostitis of the Mandible in a Child: Report of a Case Managed by Immunosuppressive Treatment. Pediatr Infect Dis J 2022; 41:e10-e15. [PMID: 34711782 DOI: 10.1097/inf.0000000000003368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Osteomyelitis with proliferative periostitis is a relatively uncommon inflammatory condition of the jaws, mainly characterized by periosteal formation of reactive bone. It primarily affects children and adolescences, also referred to as Garre's osteomyelitis, more frequently involving the molar region of the mandible. Cases lacking an obvious source of infection may have an immunologically mediated etiopathogenesis, falling under the spectrum of primary chronic osteomyelitis or chronic recurrent multifocal osteomyelitis (CRMO). CASE REPORT Herein, we present a case of chronic osteomyelitis in a 6.5-year-old girl, who suffered from recurrent painful episodes of swelling of the mandible for the last 2 years, previously requiring hospitalization and administration of intravenous (IV) antibiotics and NSAIDs with limited responsiveness. The biopsy showed features consistent with osteomyelitis with proliferative periostitis. The patient was initially managed with an IV combination antibiotic regimen with only partial improvement. The possibility of an autoimmune mechanism in the context of primary chronic osteomyelitis or CRMO was considered, and immunosuppressive therapy (TNF inhibitor etanercept along with corticosteroids and methotrexate) was administered, resulting in clinical resolution. CONCLUSIONS Osteomyelitis and its childhood variants are relatively rare and their management presents several challenges. Although typically treated with administration of antibiotics, possibly along with surgical intervention, other treatment modalities may be necessary for resilient and persistent cases. In a subset of cases, especially in the absence of local infectious factors, immunologically mediated mechanisms may play an important role and appropriate immunosuppressive therapy may be effective.
Collapse
|
13
|
Chung RT, Montejo JD, Kerr DA, Hong J. Juvenile psammomatoid ossifying fibroma of the parietal bone and review of calvarial presentations: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 2:CASE21361. [PMID: 35855183 PMCID: PMC9265227 DOI: 10.3171/case21361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/19/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Juvenile psammomatoid ossifying fibroma (JPOF) is an uncommon benign fibro-osseous lesion that only rarely presents in the calvaria. OBSERVATIONS The authors reported a case of JPOF in the left parietal bone of a 20-year-old patient and reviewed the 27 other cases of JPOF occurring in the calvaria as reported in the literature. LESSONS JPOF rarely presents in the calvaria, and because diagnosis is a histopathologic one, clinicians should consider this entity when presented with a lytic, expansile mass on imaging. Little is known about the molecular mechanisms driving development of JPOF. MDM2 amplification may play a role, although this was not seen in the case presented herein.
Collapse
Affiliation(s)
- Robert T. Chung
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; and
| | | | | | - Jennifer Hong
- Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| |
Collapse
|
14
|
Ossifying Fibromas of the Head and Neck Region: A Clinicopathological Study of 45 Cases. Head Neck Pathol 2021; 16:248-256. [PMID: 34184157 PMCID: PMC9018917 DOI: 10.1007/s12105-021-01350-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
Ossifying fibromas of the head and neck region are classified as cemento-ossifying fibroma (COF) (odontogenic origin), and two types of juvenile ossifying fibromas: juvenile trabecular ossifying fibroma (JTOF), and juvenile psammomatous ossifying fibroma (JPOF). The potential for recurrence in JTOF and JPOF and the discovery of newer molecular signatures necessitates accurate histological classification. Over 12 years (2005-2017), a total of 45 patients with 51 tumours were retrieved and reviewed for clinic-pathological features from the archives of a tertiary care oncology centre. Of 45 cases, COF, JTOF and JPOF comprised 13 (28.9%), 11 (24.4%) and 18 (40%) cases respectively. Three cases were unclassifiable. M: F ratio was 1:3.3, 1.1:1, 2:1 for COF, JTOF and JPOF respectively with an age range of 6-66 years (mean: 24.6, median; 18.1 years). The most common site for COF was mandible, for JTOF was maxilla, and for JPOF was ethmoid sinus. One case of mixed JTOF and JPOF histology was seen. Aneurysmal bone cyst-like areas were seen in 26.6% of cases, most commonly in JPOF. Follow up was available in 23 cases, and ranged from 4 to 207 months. Three cases of JPOF had a recurrence and one patient with JTOF had residual disease after surgery. One case of COF demonstrated increased parathyroid hormone levels. COF, JTOF, and JPOF are clinically, radiologically and histologically distinct entities. Surgical resection is the mainstay of treatment. JPOF has a higher incidence of recurrence as compared to JTOF and COF and hence needs a more aggressive follow-up.
Collapse
|
15
|
Abdel Razek AAK. Bone-related disorders of the jaw: A clinico-radiological diagnostic algorithm. Neuroradiol J 2021; 34:289-299. [PMID: 33678062 DOI: 10.1177/1971400921998967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bone-related disorders of the jaw (BRDJ) include a spectrum of non-neoplastic and neoplastic lesions of the maxillofacial region that have been recently classified into fibro-osseous lesions, giant cell lesions and osseous tumours. The histopathological features of BRDJ can be similar and overlie each other. Imaging is important in order to reach a specific diagnosis. However, the appearance of BRDJ on imaging is non-specific in some cases. Computed tomography (CT) and magnetic resonance imaging (MRI) are used for accurate localisation, characterisation of the tumour matrix, delineation of the lesion extension and establishment of the relation of BRDJ to the surrounding structures. Imaging is usually done to detect the relationship with the adjacent surrounding vital structures and to diagnose aggressive forms, malignant transformation and associated syndromes. The correlation of the demographic findings, the location and the clinical presentations with the imaging features are important for the diagnosis of BRDJ. The proposed clinico-radiological diagnostic algorithm with CT and MRI helps a specific diagnosis to be reached in some cases.
Collapse
|
16
|
Desai RS, Bansal S, Shirsat PM, Prasad P, Sattar S. Cemento-ossifying fibroma and juvenile ossifying fibroma: Clarity in terminology. Oral Oncol 2020; 113:105050. [PMID: 33129707 DOI: 10.1016/j.oraloncology.2020.105050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Rajiv S Desai
- Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai Central, Mumbai 400008, India.
| | - Shivani Bansal
- Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai Central, Mumbai 400008, India
| | - Pankaj M Shirsat
- Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai Central, Mumbai 400008, India
| | - Pooja Prasad
- Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai Central, Mumbai 400008, India
| | - Shumail Sattar
- Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai Central, Mumbai 400008, India
| |
Collapse
|
17
|
Bertin H, Gomez-Brouchet A, Rédini F. Osteosarcoma of the jaws: An overview of the pathophysiological mechanisms. Crit Rev Oncol Hematol 2020; 156:103126. [PMID: 33113487 DOI: 10.1016/j.critrevonc.2020.103126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/18/2020] [Accepted: 10/02/2020] [Indexed: 01/24/2023] Open
Abstract
Osteosarcoma (OS) is the most common cancer of bone. Jaw osteosarcoma (JOS) is rare and it differs from long-bone OS (LBOS) in terms of the time of onset (two decades later), lower metastatic spread, and better survival. OS is characterized by the proliferation of osteoblastic precursor cells and the production of osteoid or immature bone. OS arises from a combination of genetic aberrations and a favourable microenvironment. This local microenvironment includes bone cells, blood vessels, stromal cells, and immune infiltrates, all of which may constitute potential targets for anti-cancer drugs. Differences in the clinical and biological behaviour of JOS versus LBOS are likely to at least in part be due to differences in the microenvironment between the two sites. The present review provides a brief overview of the known pathophysiological parameters involved in JOS.
Collapse
Affiliation(s)
- Hélios Bertin
- Department of Maxillofacial Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093 Nantes Cedex 1, France; Bone Sarcoma and Remodeling of Calcified Tisues (PhyOs, UMR 1238), Nantes Medical School, 1 Rue Gaston Veil, 44035 Nantes Cedex, France.
| | - A Gomez-Brouchet
- Department of Pathology, IUCT Oncopole, Toulouse University Hospital, 1 Avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France.
| | - F Rédini
- Bone Sarcoma and Remodeling of Calcified Tisues (PhyOs, UMR 1238), Nantes Medical School, 1 Rue Gaston Veil, 44035 Nantes Cedex, France.
| |
Collapse
|
18
|
Kwon Y, Shin D, Kim J, Lee M, Choi H. Juvenile psammomatoid ossifying fibroma of the maxilla. Arch Craniofac Surg 2020; 21:193-197. [PMID: 32630994 PMCID: PMC7349133 DOI: 10.7181/acfs.2020.00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/28/2020] [Indexed: 11/17/2022] Open
Abstract
Juvenile psammomatoid ossifying fibroma (JPOF) is a rare, benign, fibro-osseous variant of ossifying fibroma. It exhibits short-term rapid growth and has a high recurrence rate. Herein we describe a case of JPOF of the maxilla that was treated via complete excision utilizing an intraoral approach with immediate reconstruction using an iliac bone graft, in conjunction with a comprehensive review of the literature. A 20-year-old man presented with a mass on his right cheek that he reported had been growing over the last 10 months. In that cheek he had noticed fullness and experienced pressure, tenderness, and fluffiness, with no other ophthalmic or dental symptoms. After clinical, radiological, and histological examinations, the diagnosis was confirmed as JPOF. Surgical excision was performed, followed by immediate reconstruction with an autologous iliac cortical and cancellous bone graft harvested from the right iliac crest under general anesthesia. Good cicatrization of the intraoral surgical wounds and right iliac crest were evident. He was monitored for 6 months after the surgery and exhibited appropriate midfacial contour. There were no signs of recurrence or complications.
Collapse
Affiliation(s)
- Yongseok Kwon
- Department of Plastic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Donghyeok Shin
- Department of Plastic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jeenam Kim
- Department of Plastic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Myungchul Lee
- Department of Plastic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Hyungon Choi
- Department of Plastic Surgery, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|