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Puranik SR, Puranik RS, Ramdurg PK, Choudhary GRC. Parosteal osteosarcoma: Report of a rare juxtacortical variant of osteosarcoma affecting the maxilla. J Oral Maxillofac Pathol 2015; 18:432-6. [PMID: 25949002 PMCID: PMC4409192 DOI: 10.4103/0973-029x.151340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 01/08/2015] [Indexed: 11/04/2022] Open
Abstract
Parosteal osteosarcomas are rare, low-grade juxtacortical variant of osteosarcoma, especially in the jaws, representing 1.6% of all bony malignant tumours and upto 5% of all osteosarcomas. Only 12 cases of intraoral parosteal osteosarcomas have been reported in the English literature. In the jaws males are more commonly affected with peak occurrence at 39 years and nearly equal site predilection for maxilla and mandible. Radiographically, parosteal osteosarcomas are radiodense, lobulated masses with a broad stalk to the cortex of the bone with no periosteal reaction and medullary invasion. Microscopically, shows well-differentiated tumor with minimum atypia and rare mitotic figures separating trabeculae of woven bone. Unlike classical and periosteal osteosarcoma, it is considered to have a good prognosis. A case report of this rare entity in 22-year-old female patient with bony hard, painless swelling of 9 months duration in maxillary premolar-molar region is presented. The need for differential diagnostic approach is emphasized from other seemingly benign clinical entities.
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Affiliation(s)
- Surekha Rudrayya Puranik
- Department of Oral Medicine and Radiology, P. M. Nadagowda Memorial Dental College and Hospital, Bagalkot, Karnataka, India
| | - Rudrayya Shivanand Puranik
- Department of Oral Medicine and Radiology, P. M. Nadagowda Memorial Dental College and Hospital, Bagalkot, Karnataka, India
| | - Praveen Kumar Ramdurg
- Department of Oral Pathology and Microbiology, P. M. Nadagowda Memorial Dental College and Hospital, Bagalkot, Karnataka, India
| | - Gunjan Ram Chandra Choudhary
- Department of Oral Medicine and Radiology, P. M. Nadagowda Memorial Dental College and Hospital, Bagalkot, Karnataka, India
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Samraj L, Kaliamoorthy S, Venkatapathy R, Oza N. Osteosarcoma of the mandible: A case report with an early radiographic manifestation. Imaging Sci Dent 2014; 44:85-8. [PMID: 24701464 PMCID: PMC3972412 DOI: 10.5624/isd.2014.44.1.85] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 05/27/2013] [Accepted: 07/08/2013] [Indexed: 11/18/2022] Open
Abstract
Osteosarcoma is a classical malignant bone-forming neoplasm which usually presents with an aggressive clinical course. The current case is presented with the radiographic feature of widening of the periodontal ligament space of the involved teeth, which is considered to be the earliest radiographic manifestation of osteosarcoma involving the jaw bone. The main aim of this case report was to focus on the importance of early diagnosis of this tumor based on clinical and radiographic examinations, and confirmation by histopathology. Considering the rarity of the disease type and particularly taking into account the fast progression and aggressiveness of this neoplasm, it is clear that the presentation of a clinical case represents a major contribution to better understanding of osteosarcomas involving the jaw bone.
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Affiliation(s)
- Lavanya Samraj
- Department of Oral Pathology and Microbiology, Mahatma Gandhi Post Graduate Institute of Dental Sciences, Pondicherry, India
| | - Sriram Kaliamoorthy
- Department of Oral and Maxillofacial Pathology, Chettinad Dental College and Research Institute, Tamilnadu, India
| | - Ramesh Venkatapathy
- Department of Oral Pathology and Microbiology, Mahatma Gandhi Post Graduate Institute of Dental Sciences, Pondicherry, India
| | - Nirima Oza
- Department of Oral Pathology and Microbiology, Mahatma Gandhi Post Graduate Institute of Dental Sciences, Pondicherry, India
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Abstract
This article describes the clinical, radiographic, and pathologic features of tumors and tumorlike lesions affecting the bones of the head and neck region. Emphasis is placed on common bone lesions affecting the craniofacial skeleton, particularly those that occur with more frequency or those that are unique to this part of the skeleton. Several of these lesions pose a diagnostic challenge to the pathologist. To ensure that a correct diagnosis is rendered, it is of utmost importance that accurate and detailed clinical and radiographic information is available.
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Affiliation(s)
- Samir K El-Mofty
- Department of Pathology and Immunology, Washington University School of Medicine, 660 Euclid Avenue, Campus Box 8118, St Louis, MO 63110, USA
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Simon D, Dominic S, Varghese KG. Juxtacortical Osteogenic Sarcoma of the Jaws: Case Report and Review of the Literature. J Oral Maxillofac Surg 2011; 69:527-31. [DOI: 10.1016/j.joms.2010.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 03/28/2010] [Accepted: 05/20/2010] [Indexed: 11/25/2022]
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Vlychou M, Ostlere SJ, Kerr R, Athanasou NA. Low-grade osteosarcoma of the ethmoid sinus. Skeletal Radiol 2007; 36:459-62. [PMID: 17091307 DOI: 10.1007/s00256-006-0231-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 09/04/2006] [Accepted: 09/27/2006] [Indexed: 02/02/2023]
Abstract
Osteosarcoma uncommonly arises in craniofacial bones and has only rarely been reported to arise in the ethmoid sinus. Most primary osteosarcomas arising in paranasal sinuses are high-grade malignancies. A low-grade osteosarcoma arising in the ethmoid sinus has not previously been described. We report the clinical, radiological and histological findings of a case of low-grade (parosteal osteosarcoma-like) osteosarcoma which arose in the ethmoid sinus.
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Affiliation(s)
- M Vlychou
- Department of Musculoskeletal Radiology, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
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Hewitt KM, Ellis G, Wiggins R, Bentz BG. Parosteal osteosarcoma: Case report and review of the literature. Head Neck 2007; 30:122-6. [PMID: 17615569 DOI: 10.1002/hed.20658] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
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.
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Affiliation(s)
- Kim M Hewitt
- Department of Surgery, Division of Otolaryngology, University of Utah School of Medicine, 50 North Medical Drive, 3C-120, Salt Lake City, Utah 84107, USA
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Abstract
Two cases of osteosarcoma of the jaws in children are reported. One patient was a 13-year-old girl whose first symptoms included nasal and maxillary sinus congestion, followed by epistaxis. She was found to have chondroblastic osteosarcoma extending through the left maxillary alveolar process and sinus. Following surgery and chemotherapy, the patient has been free of disease for 7 years. The second patient, an 8-year-old boy, was diagnosed with juxtacortical (parosteal) osteosarcoma of the mandible, which is a less aggressive variant of the neoplasm. It is believed that this is the youngest patient reported to date with juxtacortical osteosarcoma of the jaws. He was treated by block resection of the right side of the mandible and is free of disease 3(1/2) years later.
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Affiliation(s)
- M E Donaldson
- Department of Pediatric Dentistry, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, Florida, USA
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Abstract
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.
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Affiliation(s)
- M L Chindia
- Faculty of Dental Sciences, PO Box 19676, Nairobi, Kenya
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Affiliation(s)
- C B Fowler
- Oral & Maxillofacial Pathology Services, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas, USA
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Abstract
Parosteal osteogenic sarcoma (POS) is an uncommon surface bone tumor, most often arising from the metaphyseal end of long bones. Involvement of the cranial bones is rare, with only 1 case of mastoid bone POS previously reported in the literature. Two patients with POS of the mastoid are presented, 1 followed up for 25 years after surgical treatment. The presenting signs and symptoms, as well as distinctive radiographic findings, are discussed. Histologic features are also described. Typically, cranial POS appears as a sessile, densely ossified surface growth with radiating bone spicules that blend with surrounding soft tissue. Treatment is en bloc resection, which is curative in most cases.
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Affiliation(s)
- D R Seely
- Virginia Merrill Bloedel Hearing Research Center, University of Washington, Seattle, USA
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Bianchi SD, Boccardi A, Pomatto E, Valente G. Parosteal osteosarcoma of the maxilla. Dentomaxillofac Radiol 1997; 26:312-4. [PMID: 9482005 DOI: 10.1038/sj.dmfr.4600262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We describe the case of a 47-year-old female who presented with a small nodule in the buccal sulcus in the left maxillary incisor region. Clinical and radiographic examination revealed a small sclerotic neoplasm with a short pedicle. Histopathological examination confirmed a diagnosis of parosteal osteosarcoma. The contribution of CT to the diagnosis and management is discussed.
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Affiliation(s)
- S D Bianchi
- Department of Radiology, University of Torino, Italy
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August M, Magennis P, Dewitt D. Osteogenic sarcoma of the jaws: factors influencing prognosis. Int J Oral Maxillofac Surg 1997; 26:198-204. [PMID: 9180230 DOI: 10.1016/s0901-5027(97)80819-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thirty cases of osteosarcoma of the jaws were reviewed (20 men and 10 women, mean age 34 years). Seventeen lesions occurred in the mandible and 13 in the maxilla. Swelling without pain was the most common presenting symptom. Thirteen lesions were initially misdiagnosed as odontogenic infections. Numbness as a presenting symptom was statistically associated with poor prognosis. Treatment included all combinations of surgery, chemotherapy and radiotherapy. Patients receiving chemotherapy with four or more agents showed a trend toward better survival with 71% alive and disease-free at the time of review. Patients' increasing age was statistically associated with decreased survival. The average age of survivors was 27 years and nonsurvivors, 40 years. Older patients suffered more local recurrences which, in all but one case, resulted in mortality. Expectedly, clear surgical margins correlated statistically with improved survival. With margins of less than 5 mm, 27% of patients were alive and disease-free as compared to 62% with surgical margins greater than 5 mm. The importance of early diagnosis, definitive surgical treatment and aggressive adjuvant chemotherapy is demonstrated. The Proportional Hazards Regression model was employed to evaluate the statistical significance of a variety of factors on disease-free and overall survival.
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Affiliation(s)
- M August
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston 02114, USA
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Hazarika P, Nayak DR, Sahota JS, Rao D, Kapadia RD. Osteogenic sarcoma of sphenoid bone: an extended lateral skull base approach. J Laryngol Otol 1995; 109:1101-4. [PMID: 8551131 DOI: 10.1017/s002221510013213x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Osteogenic sarcoma involving the sphenoid bone is an extremely rare condition. The rarity of the disease and the close proximity of the sphenoid bone to the various important intracranial structures poses a real challenge in diagnosis and surgical management of these lesions. An extended lateral craniofacial resection by a multidisciplinary approach was carried out in one such case to attempt en bloc resection. This case is presented and also a review of the relevant literature.
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Affiliation(s)
- P Hazarika
- Department of Otolaryngology, Kasturba Medical College and Hospital, Manipal, South India
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Abstract
Presented is a case report of osteosarcoma of the maxilla in a patient with Paget's disease. This case is unusual because of recurrent benign soft tissue enlargements at the site of eventual malignant disease.
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Affiliation(s)
- S D Vincent
- Department of Oral Pathology, Radiology, and Medicine, University of Iowa College of Dentistry, Iowa City 52242
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Vege DS, Borges AM, Aggrawal K, Balasubramaniam G, Parikh DM, Bhaser B. Osteosarcoma of the craniofacial bones. A clinico-pathological study. J Craniomaxillofac Surg 1991; 19:90-3. [PMID: 2037699 DOI: 10.1016/s1010-5182(05)80614-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Thirty-four cases of osteosarcoma involving the craniofacial bones over a period of 19 years were reviewed. They formed 6.2% of osteosarcomas occurring in the skeleton during the same period at the Tata Memorial Hospital. Mean age of occurrence was 30.9% years, with a range of 7 to 61 years. Male preponderance was noted in maxillary tumours (M:F = 2.6:1), while the mandibular tumours occurred with equal frequency in both sexes. The mandible was the bone of origin in 56%, maxilla in 32% and other craniofacial bones in 12% of patients. Histological sub-type did not affect the prognosis. Radical surgery with resection of adequate disease-free margins is the most effective mode of treatment. Morbidity and mortality is due to extensive local recurrence of disease, particularly with maxillary tumours. Metastasis to other organs occurs rarely. No statistically significant difference in survival was observed between tumours of the mandible and maxilla, or between patients above and below 20 years of age.
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Affiliation(s)
- D S Vege
- Dept. of Pathology, Tata Memorial Hospital, Bombay, India
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Patterson A, Greer RO, Howard D. Periosteal osteosarcoma of the maxilla: a case report and review of literature. J Oral Maxillofac Surg 1990; 48:522-6. [PMID: 2184205 DOI: 10.1016/0278-2391(90)90246-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- A Patterson
- United States Institute of Dental Research, Department of the Army, Walter Reed Army Medical Center, Washington, DC 20307-5300
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Abstract
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.
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Affiliation(s)
- B G Millar
- Department of Oral Surgery and Oral Pathology, Birmingham Dental Hospital
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Adekeye EO, Chau KK, Edwards MB, Williams HK. Osteosarcoma of the jaws--a series from Kaduna, Nigeria. Int J Oral Maxillofac Surg 1987; 16:205-13. [PMID: 3110321 DOI: 10.1016/s0901-5027(87)80132-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
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Zarbo RJ, Regezi JA, Baker SR. Periosteal osteogenic sarcoma of the mandible. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1984; 57:643-7. [PMID: 6588346 DOI: 10.1016/0030-4220(84)90287-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Periosteal osteosarcoma, a variant of juxtacortical osteosarcoma, is seldom seen in the jaws. The clinical, radiographic, and histopathologic features of a rare mandibular periosteal osteosarcoma presenting as a deep mass in the area of the parotid are reported. The clinicopathologic features that distinguish this lesion from the more common parosteal osteosarcoma are also discussed.
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Clinical and Histological Aspects of Oral Malignancies, Excluding Squamous Cell Carcinomas and Salivary Gland Tumours. Oral Oncol 1984. [DOI: 10.1007/978-1-4613-2845-2_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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