Parosteal osteosarcoma of the maxilla

Malignant Transformation of Ossifying Fibroma into Parosteal Osteosarcoma with High-grade Component: Presentation of an Unusual Case and Review of the Literature

Background:

Parosteal Osteosarcoma of the Jaw (POSJ) is a rare entity that is associated with a high survival rate. Several case reports and case series of POSJ have been published in the literature, but few authors have described development of this tumor by possible transformation from a fibro-osseous neoplasm.

Objective:

We present a rare occurrence of parosteal osteosarcoma with involvement of the posterior maxilla, orbit floor, and infra-temporal fossa in a 20-year-old man. Furthermore, we performed a literature review regarding clinical, radiological, and histological features; treatment strategies; and etiology/pathophysiology.

Methods:

A PubMed search yielded a total of 74 articles and the articles were sorted according to their corresponding key area of focus.

Results:

This was a case of POSJ with high-grade component in the maxillofacial region of a 20-year old male. Co-expression of MDM2 and CDK4 was confirmed. At 2.5-year follow-up, the patient had died. The literature review revealed 18 articles including 20 cases of POSJ. Four cases represent the possible development of this tumor by transformation from a fibro-osseous neoplasm: Two cases of fibrous dysplasia, one case of cemento-ossifying fibroma, and the case of Ossifying Fibroma (OF) in the present study.

Conclusion:

In conclusion, we found an unusual case of POSJ of the midface in a patient with a previous diagnosis of OF in the same region. To our knowledge, there have been no previous reports of development of POSJ in OF. Furthermore, this is the first described case of high-grade surface osteosarcoma in the craniofacial region.

Well-differentiated osteosarcoma of the jaw bones: a clinicopathologic study of 15 cases

Well-differentiated osteosarcoma of the jaw bones is rare, and is often confused with a variety of benign fibroosseous lesions. To better understand its clinicopathologic features, we reviewed our experience with 15 cases. The patients included 7 males and 8 females (age range 14 to 66 y; mean 42.8 y). Six of the tumors arose in the mandible, and 9 in the maxilla. Microscopically, the tumors were infiltrative, relatively hypocellular, and consisted of monomorphic, minimally atypical spindle cells that were usually arranged in fascicles. The tumor cells were intimately related to the surfaces of elongated trabeculae of neoplastic woven bone that lacked osteoblastic rimming. Nine patients were treated with wide excision, 2 patients with marginal excision, and 2 patients with excision and radiation therapy. After definitive therapy, there were no reports of recurrence or metastasis over an average follow-up of 34 months (range 1 to 80 mo). Well-differentiated gnathic osteosarcoma is a low-grade malignancy that may be successfully treated with wide local excision. The prognosis in our series was excellent.

Parosteal osteosarcoma: report of a case and review of the literature

Parosteal osteosarcoma is a rare malignancy of the bone that usually arises in the long bones. Involvement of the oral cavity is rare. Only 12 cases of intraoral parosteal osteosarcoma have been reported in the English language literature. This paper defines the major clinical, radiographic and histologic features of parosteal osteosarcoma and illustrates these with a case of a 33-year-old male presenting with a three-month history of a painless enlarging lump in the right maxilla. A critical and comprehensive review of the English language literature is also provided.

Parosteal osteosarcoma: Case report and review of the literature

BACKGROUND

The majority of osteosarcoma cases of the head and neck are high-grade lesions. We present a case and discuss the diagnostic and therapeutic implications of a rare low-grade parosteal osteosarcoma of the maxilla.

METHODS

A 32-year-old man presenting to the Head and Neck Surgical Oncology clinic with a 1-year history of a firm palatal mass. Evaluation clinically and radiographically raised the suspicion of an osteosarcoma.

RESULTS

A partial maxillectomy revealed a parosteal osteosarcoma with negative margins. No adjuvant therapy was recommended, and the patient remains without evidence of local recurrence after 3 years.

CONCLUSIONS

Parosteal osteosarcomas of the head and neck region are rare, low-grade variants of osteosarcoma, but have the potential to recur with simple local excision. Clinical and radiographic features are diagnostically helpful. Definitive diagnosis comes from histopathology, and wide local resection should be employed as the optimal treatment.

Osteosarcoma of the jaw bones

Currently, it has been established that osteosarcoma (OS) of bone is not a stereotyped disease, and several varieties have been identified by clinical findings, radiographic and histopathologic appearances. Generally, it is the most common primary malignant bone neoplasm that accounts for at least 30% of all primary tumours of bone. In the jaw bones, OS accounts for about 4% of all the primary malignant neoplasms. In the general skeleton, the highest incidence is observed in the second decade of life; the neoplasm is said to be unusual before the age of 5 years and very rare after age 50 years. The aetiology and precise pathogenesis of this disease remain unknown. A diagnosis of clinically and radiologically suspicious OS requires meticulous histologic examination. However, histologic diagnosis may also be difficult since the different varieties of OS may have different morphological patterns in different sample sites. Currently, the two therapeutic modalities used in the primary treatment of OS include radical surgery and cytotoxic chemotherapy. In the general skeleton, the use of surgery alone results in a 90% rate of recurrence of OS. Notably, the advent of adjuvant and neoadjuvant cytotoxic chemotherapy as an adjunct to radical surgery has greatly improved the prognosis of many cases of OS of the jaw bones.

Periosteal osteosarcoma of the maxilla: a case report and review of literature

Juxtacortical osteosarcomas, including periosteal and parosteal subtypes, are uncommon neoplasms of the jaws. In long bones, the biologic behavior of the periosteal variant is reported to be more aggressive than the parosteal tumor. Juxtacortical osteosarcoma of the jaws appears to have a slightly more favorable prognosis than in long bones, although a larger series of cases needs to be evaluated before a definitive conclusion concerning the behavior of juxtacortical osteosarcoma of the jaws can be made.

Juxtacortical osteosarcoma of the jaws

Osteosarcoma is a highly malignant tumour which despite modern surgery and chemotherapy still retains a relatively poor prognosis. This prognosis is, however, much better in the rare variant known as juxtacortical osteosarcoma. Both types of osteosarcoma mainly affect the long bones but the juxtacortical variant may be treated less aggressively and has a much better survival rate. The authors report four cases of juxtacortical osteosarcoma affecting the jaws and discuss these unusual tumours and their management.

Osteosarcoma of the jaws--a series from Kaduna, Nigeria

15 primary and one metastatic osteosarcoma of the jaw bones in Nigerians are described. The age range was typical of this tumour; most cases were in the mandible. Clinical and radiographic features were often diagnostic but the microscopic appearances were varied and problematical. No metastases were detected and effective surgical treatment depended upon the degree of spread in soft tissue. Inoperable tumours had infiltrated the pharyngeal and tonsillar area. Some resected cases survived for one year or more.

Juxtacortical osteogenic sarcoma of the jaws. Review of the literature and report of a case

The juxtacortical osteogenic sarcoma is a rate tumor, especially in the jaws. Until now, only six cases have been reported. Before describing an additional case in the mandible, it was deemed appropriate to review the literature on juxtacortical osteogenic sarcoma in extracraniofacial locations as well. The data on juxtacortical osteogenic sarcomas of the long bones and those of the jaws are discussed.