Primary intraosseous carcinoma: report of two cases

Squamous Cell Carcinoma Arising in a Squamous Odontogenic Tumor of the Maxilla: Case Report and Review of the Literature

Squamous odontogenic tumor (SOT) is an exceedingly rare, benign epithelial odontogenic tumor showing squamous differentiation. It is composed of variably sized and shaped islands of cytologically bland, mature squamous epithelium within a fibrous stroma. In this report, we present a rare transformation of a squamous odontogenic tumor (SOT) of the maxilla into a well-differentiated squamous cell carcinoma (SCC) with involvement of the pterygoid plates. To the best of our knowledge, only two cases of malignant transformation of SOT has been reported in the literature. Herein, we seek to report this extremely rare occurrence to raise awareness of oral and maxillofacial surgeons and pathologists of this unusual, but serious event and perform a literature review of squamous odontogenic tumors.

[De novo (type 3) primary intraosseous carcinoma of the jaws]

INTRODUCTION

Primary intraosseous carcinoma (PIOC) of the jaws is a rare epidermoid carcinoma from epithelial origin and initially strictly localized within the bone. Histologically, type 3 PIOC (PIOC3) is a de novo primary intraosseous carcinoma. Because of the rarity of this illness, we propose an analysis of a personal case and a revue of the literature.

MATERIAL AND METHODS

Two search engines (Pubmed^®, Sciencedirect^®) were questioned over the period 1976-February 2016 by using following keywords carcinoma, intraosseous, jaws, squamous cell carcinoma. Articles reporting proven PIOC3 and mentioning a precise treatment were selected.

RESULTS

Thirty articles concerning 54 patients (sex ratio: 2.4; mean age: 56.8; extreme: 24-78) met the inclusion criterions. The most common symptoms were swelling (53%), pain (44.9%) and infra-alveolar nerve paresthesia (30.6%). The time to diagnosis was 13 weeks. Classification of Zwetyenga et al. showed more than 80% of T2 and T3 stages. The lesions were predominantly mandibular (85.2%) and posterior. Less than a third of patients had lymph node and 10% had distant metastasis. Treatment consisted mostly in a combination of surgery and radiotherapy. With a mean follow-up of 74.8 months, 70.8% were in remission with no evidence of recurrence. We report the case of a 58-year-old patient, with no medical history, complaining since several months about periodontitis with teeth mobility in the right mandibular area. The panoramic X-ray showed a bone lysis at the place of tooth No. 46. In the absence of alveolar healing after extraction and antibiotherapy, a biopsy was made that diagnosed a differentiated keratinizing squamous cell carcinoma. CT scan and MRI showed a mandibular cortical bone loss with involvement of adjacent structures and lymphadenopathy in the ipsilateral IB area. The patient was treated with a combination of chemotherapy and surgery. Postoperative chemo- and radiotherapy is still going on.

DISCUSSION

The PIOC3 is a rare tumor, mainly arising in males around 50. Diagnosis should be evoked in the presence of painful swelling and nervous symptoms. The time to diagnosis is long. Tumors are usually seen at late stages. Treatment classically combines surgery and radiotherapy.

Solid-type primary intraosseous squamous cell carcinoma of the mandible: a case report with histopathological and imaging features

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare malignant odontogenic tumor arising from odontogenic epithelial remnants within the jawbones. PIOSCC is histopathologically divided into 3 types: solid-type carcinoma, carcinoma derived from a keratocystic odontogenic tumor, and carcinoma derived from an odontogenic cyst. In this article, we report a case of solid-type PIOSCC involving reactive bone formation in the mandible in a 60-year-old female patient together with its histopathological and imaging findings.

Primary intraosseous carcinoma of the mandible: A report of two cases

Primary intraosseous carcinoma arising as a de novo lesion is a unique and rare carcinoma affecting the jaws, especially at younger ages. Two case reports, a 26-year-old Indian female with primary intraosseous squamous cell carcinoma and a 16-year-old Indian male with intraosseous carcinoma arising in an odontogenic cyst, both within the body of the mandible, are presented here.

Recommendation of modified classification for odontogenic carcinomas

Primary squamous cell carcinoma (SCC) derived from odontogenic epithelium is diagnosed as primary intraosseous carcinoma (PIOC). The term "intraosseous" means the bone marrow spaces. Odontogenic cells, however, exist not only in the bone marrow space but also in the periodontal space and the subepithelial soft tissue space. In our survey for 36 SCC lesions of odontogenic origin, many lesions involved two or all of the three spaces. There was only one lesion which involved the bone marrow space alone. In some cases, the extent of the early lesions was restricted around the tooth or at a part of the alveolar crest. The possibility of a SCC of odontogenic origin arising in the periodontal and the subepithelial soft tissue spaces was suggested. We proposed the term "Odontogenic SCC" to replace "PIOC".

Primary intraosseous carcinoma of the jaw: pooled analysis of world literature and report of two new cases

Primary intraosseous carcinoma (PIOC) is a rare malignant neoplasm of the jaw. These tumours are believed to arise from the odontogenic epithelium and hence are also referred to as odontogenic carcinoma. A detailed search was made for squamous cell PIOC of the jaw in English literature using Medline Cancer CD. The data obtained were transferred onto dBase software. Two detailed case reports of patients treated at Regional Cancer Centre, Trivandrum during 1996 and 1997 were also included. A pooled analysis was carried out. Survival analysis was carried out using Kaplan-Meier method and log-rank statistics were used for comparing survival. A total of 35 cases were analysed, of which 33 were from published literature. The mean age of the patients at the time of diagnosis was 52.3 years with male to female ratio being 2.5:1. Posterior mandible was the predominant site. The median follow-up time was 28 months. Overall survival at 5 years was 37.8% (95% CI; 14.8-61.0) while the corresponding disease free survival was 29.8% (95% CI; 9.2-54.1). Primary intraosseous carcinoma is a rare tumour of jawbones, characterized by progressive swelling of the jaw, pain and loosening of tooth. The tumour is locally aggressive and metastasizes to regional nodes. The overall and disease free survival is poor with almost 50% patients failing loco-regionally within the first 2 years of follow-up.

Primary intraosseous carcinoma of the mandible--a case report and review of the literature

BACKGROUND

Squamous cell carcinoma arising within bone is a rare lesion and is only seen essentially in the jaw bones.

METHODS

A case of primary intraosseous carcinoma arising in the mandible is reported in a 60-year-old female patient. Twenty-eight cases of primary intraosseous carcinoma published in the literature, till date, are reviewed.

RESULTS

The mean age of the patients at the time of diagnosis was 53 years and the male: female ratio was 2.2:1. The posterior mandible was the predominant site. Fourteen of 28 patients presented with routine dental disorders, while eight patients complained of swelling, four of severe pain and three had sensory disturbances. The incidence of lymphadenopathy was 10 (34.481%) out of the 29 cases reviewed here. Wide surgical excision is accepted as the treatment of choice.

CONCLUSION

The most common presenting symptom of these tumours is swelling and persistent pain in the jaw. Hence, in making a diagnosis one is likely to consider benign dental conditions. The importance of considering intraosseous carcinoma as a possibility in all cases of persistent pain and swelling in the jaw is emphasized so that suitable treatment can be instituted early.

Intraosseous squamous cell carcinoma arising in association with a squamous odontogenic tumour of the mandible

We report a rare occurrence of intraosseous squamous cell carcinoma (SCC) arising in association with a squamous odontogenic tumour (SOT), which had not previously been documented in the literature. A 53-year-old man had, for 5 years, a well-demarcated radiolucency attached to the impacted third molar of the mandible. The enucleated specimen had a characteristic pattern of SOT, but in which a few epithelial islands showed atypical features suggestive of SCC. Intense p53-, proliferating cell nuclear antigen- and Ki-67-positive cells were detected in carcinoma areas. Within 2 months, aggressive bone destruction showing typical findings of intraosseous SCC appeared. The present tumour is presumably a malignant variant of SOT.

Primary intraosseous carcinoma: review of the literature and diagnostic criteria

Twenty-four reports describing 39 cases of primary intraosseous carcinoma (PIOC) were reviewed and the clinicopathologic features were summarized. The mean age of the patients at the time of diagnosis was 51.0 years, and the male: female ratio was 2:3. The posterior mandible was the predominant site; in no patient was a lesion observed in the posterior maxilla. Twenty-five of 31 patients (80.6%) showed swelling of the oral mucosa. However, ulcer formation was observed in only 3 of 36 patients. Pain, sensory disturbances, and metastasis to regional lymph nodes were observed in 25 of 34 patients (73.5%), 9 of 15 patients (60%), and 13 of 33 patients (39.4%), respectively. Radiographically, most lesions produced bone resorption with ill-defined margins (51.6%) or with well-defined margins (19.4%). The diagnostic criteria proposed for PIOC are absence of ulcer formation, except when caused by other factors; histologic evidence of squamous cell carcinoma without a cystic component or other odontogenic tumor cells; and absence of another primary tumor on chest radiographs obtained at the time of diagnosis and during a follow-up period of more than 6 months.

Primary intraosseous squamous carcinoma. Report of two cases

Two cases of primary intraosseous squamous carcinoma (PIOSC) are reported. One PIOSC is in the mandible of a 24-year-old man and appears to be a keratinizing PIOSC arising de novo. The other PIOSC presented in the edentulous maxilla of a 56-year-old man and was diagnosed as a PIOSC arising from an odontogenic cyst. The 2nd tumor subsequently metastasized to a cervical lymph node. Previous reports have noted a favorable prognosis for PIOC arising in odontogenic cysts, and only 3 other instances of metastases of a PIOSC in an odontogenic cyst have been documented.

Ameloblastic carcinoma. Report of an aggressive case and review of the literature

Odontogenic carcinomas of the jaws are classified as malignant ameloblastoma, ameloblastic carcinoma or primary intraosseous carcinoma. Because these lesions are extremely rare, microscopic diagnosis is difficult. An aggressive case of ameloblastic carcinoma of the mandible is presented. In spite of radical surgery and radiotherapy, the patient expired eight months following initial diagnosis. - A review of the literature seems to indicate that so called simple ameloblastomas rarely can dedifferentiate and metastasize following multiple inadequate surgical procedures. Although radical surgery is not necessary, local excision should be thorough. - Ameloblastic carcinoma and primary intraosseous carcinomas may be histogenetically similar. They are highly malignant tumours which should be treated aggressively. Metastasis is common and prognosis is poor.

Primary intraosseous carcinoma of the jaws. Three new cases and a review of the literature

Three new cases of primary intraosseous carcinoma are presented. The clinical features of these cancers often mimics odontogenic cysts, dental abscesses or periodontal disease; all benign dental conditions. This may delay the diagnosis and probably accounts for the poor prognosis associated with these tumours of 30-40% 5-year survival. A total of 24 cases of primary intraosseous carcinomas have been analysed, which includes reports collected from the literature and the three new cases presented in this paper.

Invasive squamous cell carcinoma of the mandible presenting as a chronic osteomyelitis: report of a case

A case of invasive squamous cell carcinoma of the mandible initially thought to be chronic osteomyelitis is reviewed. Discussion of the origin of the tumor and several imaging techniques used for differentiating maxillofacial infection from neoplasm are discussed. The difficulty of diagnosis of chronic painful maxillofacial lesions illustrates the need for a high degree of suspicion concerning any inflammatory lesion not responding to appropriate therapy. Accurate diagnosis and treatment of such lesions most often necessitates microscopic examination.