Ewing's sarcoma: metastatic tumor to the jaw

A rare case of Ewing sarcoma metastasis to the oral cavity

Ewing sarcoma in the head and neck is rare, and metastasis from other bones to the mandible accounts for 0.7% of cases. This report presents a case of oral metastasis in a 24-year-old male patient diagnosed with Ewing sarcoma of the femur (p53 gene mutation and EWSR1-ERG fusion). The chief complaint was numbness in the mandible and pain for 1 month and a hardened, ulcerated exophytic lesion in the right retromolar region. Imaging exams revealed an unspecified thinning of the cortical bone of the inferior alveolar canal in the right mandibular ramus, associated with erosion of the alveolar bone. Histopathological analysis confirmed metastasis of Ewing sarcoma. The patient presented an aggressive disease progression and died 1 month after the oral diagnosis. It is important to recognize the signs and symptoms compatible with rare clinical outcomes, leading to an early diagnosis that can improve patients' quality of life and survival.

Prosthodontic treatment of a patient with Ewing sarcoma of the left maxillary sinus: A clinical report

This clinical report describes the prosthodontic rehabilitation of a 22-year-old woman with a substantial treatment history of Ewing sarcoma of the left maxillary sinus. The patient was diagnosed with Ewing sarcoma at the age of 7 years and went through chemotherapy, radiation, surgical resection, and free-flap reconstruction, initially without prosthodontic rehabilitation. The patient aged 22 years was referred to the oral oncology clinic at The University of Texas MD Anderson Cancer Center for prosthodontic treatment. The patient's prosthetic rehabilitation with dental implants and a definitive maxillary obturator prosthesis is presented in detail.

Ewing's Sarcoma Family Tumors in the Jaws: Case Report, Immunohistochemical Analysis and Literature Review

Due to the low incidence of the Ewing's Sarcoma (ES) family tumors, the available epidemiology is likely to be unreliable, and at present, there are no standard diagnostic or clinical guidelines outlining their management. This report describes a case of peripheral primitive neuroectodermal tumor (ES/pPNET) which initially mimicked cystic lesions, and describes a comparison between ES and ES/pPNET in the jaws by the World Health Organization classification. This review addressed 63 cases published in the English literature between 1950 and 2016. The majority of cases were ES. Both ES and ES/pPNET mimicked other benign entities such as traumatic, cystic and inflammatory lesions. The patients who died of their disease had a history of metastatic tumors, and primary tumor located in the mandible and maxilla for ES and ES/pPNET, respectively. The differentiation of the ES family tumors from other small blue-cell tumors may be difficult and requires familiarity with histological and immunohistochemical features.

Metastasis to the Jawbones: A review of 453 cases

The purpose of the present article was to review the characteristics of the jawbone metastases to analyze all variables. A relevant English Literature search in PubMed, Scopus, and Google Scholar was performed. All variables such as age, gender, primary and secondary tumor sites were analyzed. There were 453 metastatic cases. The male-to-female ratio was 1.2:1, and the mean age of the patients was 53.4 years. The lung was the most common primary site in men, and breast in women. The most common metastatic site was the mandible, and adenocarcinoma was the most frequent histological diagnosis. Metastases to the jaw bones occur in the advanced stages of a malignancy hence; a careful examination of patients with jaw bone lesions is strongly suggested. Dentists, as well as general physicians, should take into consideration the possible presence of jaw metastases in cases which present atypical symptoms, especially in patients with known malignant disease.

Ewing sarcoma of the oral cavity. A review

Objectives

A review is made of the clinical, diagnostic, therapeutic and survival characteristics of Ewing sarcoma (ES) of the oral cavity.

Material and Methods

A systematic literature search was carried out, with restrictions referred to time (1960-2014), language (English and Spanish) and type of study (case reports, letters, datasets, reviews). The following MeSH terms and boolean operators were used: Ewing AND Sarcoma AND [tongue, jaw, maxilla, cheek, condyle OR temporomandibular, floor AND mouth, gum OR gingiva, palate OR palatal, lip, uvula, head AND neck].

Results

Seventy-one cases of ES of the oral cavity were documented from 53 articles. The main differences versus ES of other locations were a younger age at manifestation, a shorter time from symptoms onset to diagnosis, and swelling as the most frequent clinical manifestation versus swelling and pain in the rest of disease locations. The way in which ES manifests in the oral cavity is varied and comprises dental displacement (19.7%), dental mobility (7%), root reabsorption (5.6%), destruction of the dental follicle (4.2%), premature exfoliation (4.2%) and paresthesia of the chin (2.8%). Metastatic neck adenopathies appear in 11.3% of the cases. Significant differences in survival are observed between patients with a complete diagnosis of ES (hematoxylin-eosin staining, PAS positivity, CD99 positivity) and those with an incomplete diagnosis.

Conclusions

Ewing sarcoma of the oral cavity presents a series of specific features that distinguish it from ES of other locations.

Key words:Primitive neuroectodermal tumor, PNET, Ewing sarcoma, Ewing tumor, sarcoma, oral cavity.

Metastasis to the oral soft tissues: A review of 412 cases

The present review article analyzes the characteristics of metastases to the oral soft tissues from 1937 to 2015. An extensive literature search was performed. All variables such as age, gender, and primary and secondary tumor sites were analyzed. Metastases to the major salivary glands were not included in this review. In general, there were 412 metastatic lesions developed in the oral soft tissues. The male-to-female ratio was approximately 1.8:1. The mean age of the patients at diagnosis was 58. The lung was the most common primary site and the gingiva was the most common metastatic site. The greater part of the histological examination yielded adenocarcinoma. The diagnosis of a metastatic lesion in the oral cavity is a challenge to the clinicians due to the lack of pathognomonic signs and symptoms. Oral metastases usually occur in the advanced stages of cancers, and the interval between appearance and death is usually short. The oral soft tissue metastasis can be easily recognized compared to the metastasis of jawbones. Early detection of oral lesions is important in the case of being the first sign of a malignancy in other parts of body.

Ewing's Sarcoma Localized in the Mandible: A Case Report

Ewing's sarcoma is one of the most aggressive primary bone tumours. Ewing's sarcoma arising from the bones of the head and neck region is extremely rare; only 4-9% of all Ewing's sarcoma originate in this region. We report a case of Ewing's sarcoma localized in the mandible because of its unusual presentation.

Validating of the pre-clinical mouse model for metastatic breast cancer to the mandible

Metastatic breast carcinoma has a great tendency to spread to the mandible. It is concomitantly associated with bone destruction, food intake disorder, and a poorer prognosis. Appropriate animal models need to be developed for a better understanding of the mechanisms underlying the metastatic process of breast cancer cells to mandible and to test the effects of potential lead compounds. Here, we assessed the metastasis model of intracardiac injection using luciferase-transfected metastatic breast cancer cells (MDA-MB-231^Luc+) by determining the incidences of metastasis, mCT images, and histopathological results. A high bioluminescence signal mainly detected mandibular lesions with less frequent distal femora and proximal tibiae lesions. Extensive mandibular bone destruction occurred in nude mice grafted with metastatic breast cancer cells. This type of animal model might be a useful tool in assessing therapeutic implications and the efficacy of anti-cancer drugs for osteolytic cancers.

Metastatic tumors to the oral and maxillofacial region: a retrospective study of 19 cases in West China and review of the Chinese and English literature

PURPOSE

The aim of this article was to obtain an overview of metastatic tumors to the oral and maxillofacial (OMF) region, especially the differences in the constituent ratios of primary cancers between the United States and China.

PATIENTS AND METHODS

Clinical findings of 19 cases encountered in West China Hospital of Stomatology were summarized and the English and Chinese literature were reviewed and analyzed. The main clinical features of OMF metastases were summarized, with an emphasis on primary cancers' constituents.

RESULTS

The lung, breast, kidney, liver, and prostate were the top 5 common primary sites of cancer. However, there was a significant difference in the primary cancers' constituents between United States and China (P < .001). The breast, kidney, prostate cancers, and melanoma of skin were more frequent primary cancers in United States than in China, whereas that of the lung, thyroid, liver, esophagus, and the stomach were more common in China than in United States. The proportions of the OMF metastatic lesions originating in the lung, kidney, liver, thyroid, and esophagus in all OMF metastatic tumors were higher than the corresponding primary cancers' prevalent proportions.

CONCLUSIONS

The frequency of developing OMF metastasis is not always consistent with primary cancers' prevalence, which suggests that different cancers have different potentiality to develop OMF metastasis. Cancers of the kidney, liver, lung, thyroid, and esophagus were more likely to spread to the OMF region. In general screening of primary cancer, it would be helpful to take into account the metastatic potentiality of different cancers and primary cancers' prevalence in different countries in the case of occult primary.

Imaging findings of Ewing's sarcoma in the mandible

First described by James Ewing in 1921, Ewing's sarcoma (ES) or Ewing's tumor is one of the most aggressive bone tumors known. ES is an uncommon intra-osseous malignant tumor of questionable pathogenesis that occurs in children and young adults. Reports indicate that only 2 to 7% of cases involve the maxillofacial region, usually the mandible ramus, and few reported cases have involved the maxilla. In the present report of a case of ES of the mandible, we describe the results of imaging and evaluation after therapeutic treatment. This report provides a rare opportunity to observe radiologic features of ES in the mandible.

The clinical and diagnostic imaging findings of osteosarcoma of the jaw

OBJECTIVE

To clarify the valuable clinical features and diagnostic imaging findings regarding the diagnosis of osteosarcoma of the jaw (OSJ).

MATERIALS AND METHODS

The initial symptoms and diagnostic imaging findings of 10 patients with OSJ were analysed. The points analysed on the diagnostic images were as follows: any widening of the periodontal ligament space of the teeth on the periphery of the OSJ; the presence of radial spicules and Codman's triangle; any signs of bone destruction; and the patterns of osteogenesis.

RESULTS

All patients had pain and/or swelling of the affected site, and all OSJs, except for one edentulous case, showed a widening of the periodontal ligament space of the teeth on the periphery of the OSJ. Radial spicules or Codman's triangle were observed in only three cases (30%). Four out of five mandibular OSJs were osteolytic or osteolytic dominant with bone destruction, while, in contrast, four out of five maxillary OSJs were osteogenic or osteogenic dominant, and three out of the four maxillary OSJs did not show bone destruction. The osteogenic OSJ without bone destruction was similar to some benign cemento-osseous lesions of the jaw and thus was difficult to diagnose as OSJ based on the diagnostic imaging findings alone.

CONCLUSION

Even though some OSJ showed features similar to the benign tumours of the jaw bone based on the diagnostic imaging findings, the pain and swelling of the affected site, and the widening of the periodontal ligament space of the teeth on the periphery of OSJ were considered to be common findings, which may help in making an accurate diagnosis of OSJ in this limited series.

EWING'S SARCOMA OF MANDIBLE - A RARE NEOPLASM

Ewing's sarcoma is a highly malignant tumour seen in the age group of 5 to 25 years, primarily afflicts long bones of the extremities followed by pelvis, ribs and vertebrae. The involvement of this lesion in the mandible accounts for only 2% of the reported cases. Ewing's sarcoma particularly in children, poses difficulty in arriving at a diagnosis and could be established only by histopathological and electron microscopic examination. This is a radiosensitive lesion, however, surgery with chemotherapy is the preferred treatment of choice in mandible. A case of Ewing's sarcoma in a 7 year old female patient was managed by chemotherapy and aggressive surgical approach with gratifying results and no recurrence till date.

Ewing's sarcoma of the mandible: radiologic features with emphasis on magnetic resonance appearance

Ewing's sarcoma is an uncommon malignancy that usually occurs in children. A case of Ewing's sarcoma of the mandible is presented, and the radiologic appearance is described, with special consideration given to the magnetic resonance imaging features.

Ewing's sarcoma and peripheral primitive neuroectodermal tumor: an interim report

The primitive neuroectoderm and its progeny seemingly give rise to an ever-increasing number of clinicopathologic entities. Ewing's sarcoma and peripheral primitive neuroectodermal tumor have recently been united by relatively unique antigens expressed by the MIC-2 gene, commonly coexpressed neural markers, and cytogenetic and molecular genetic abnormalities. Because of these factors, the current thinking is that Ewing's sarcoma and the peripheral primitive neuroectodermal tumor are parts of a phenotypic spectrum. We present an "interim report" on this group of neoplasms, emphasizing their presentation in the head and neck.

Ewing's sarcoma of the mandible: a case report

Ewing's sarcoma is an uncommon malignancy that usually occurs in childhood and is rare in the mandible. A case of Ewing's sarcoma of the mandible is presented and discussed.

Metastatic tumors to the jawbones: analysis of 390 cases

A review of the English language literature revealed 390 well-documented cases of metastatic lesions to the jawbones. Most metastatic lesions were diagnosed in patients in their fifth to seventh decade. The primary site differed between the genders: for women, it was the breast followed by the adrenal, colo-rectum, female genital organs and thyroid; for men, it was the lung, followed by the prostate, kidney, bone and adrenal. The most common location of the metastatic tumors was the mandible, with the molar area the most frequent site involved. In about 30% of cases the oral lesion was the first sign of the malignant disease. The present data are compared with those of metastatic tumors to the oral mucosa and a view on the possible pathogenesis is presented.

Ewing's tumor of the mandible

A primary Ewing's tumor in the mandible is reported, and the diagnostic imaging features of this lesion are discussed. Modalities used included panoramic and plain films, computed tomography, and 99mTc-MDP scintigraphy.