Solid-type primary intraosseous squamous-cell carcinoma in the mandible: Report of a rare case

Outcome of primary intraosseous carcinoma: cases review of a single institution

OBJECTIVE

The purpose of this study was to investigate the prognostic factors and treatment of primary intraosseous carcinoma.

METHODS

Patients diagnosed with primary intraosseous carcinoma and received treatment in Sichuan cancer hospital from 2000 to 2019 were followed up and retrospectively reviewed.

RESULTS

A total of 28 patients were included in the study, with a mean age of 60 years (60±10.11). The 2-year and 5-year overall survival were 60.7% and 38.5% respectively. In the univariate analysis, surgery combined with adjuvant therapy improved the overall survival compared with surgery or radiotherapy alone (P=0.035), and patients received postoperative adjuvant radiotherapy had a higher overall survival than those who received radical radiotherapy (P = 0.01). In addition, patients with well differentiated tumors have increased progression free survival (P=0.01). Multivariate analyses showed that radiotherapy was an independent indicator for overall survival (P = 0.007).

CONCLUSIONS

surgery combined with adjuvant therapy is the superior treatment strategy for primary intraosseous carcinoma at present. This study is the first to confirm the positive role of radiotherapy in treating primary intraosseous carcinoma with data to back it up.

Solid type primary intraosseous squamous cell carcinoma in a cat

Background

Squamous cell carcinoma (SCC) is the most common nonodontogenic oral tumor in cats. In the jaw, it usually presents as an ulceroproliferative lesion associated with enlargement of the affected bone.

Case presentation

This report describes the case of a cat in which clinical and radiographic findings of a mandibular swelling were suggestive of an aggressive process, but the oral mucosa was unaffected. The results of histopathological and immunohistochemical examination of the samples obtained from the intraosseous lesion were consistent with SCC. The animal was euthanized 5 months after initial presentation as a result of the severe progression of the disease, and no other primary tumors were identified at necropsy.

Conclusions

Based on the clinicopathological, microscopic, and immunohistochemical staining features, as well as the absence of a primary tumor at a distant site, we propose that the term, solid type primary intraosseous SCC (PIOSCC), be used to describe this neoplasia, as it shares similar features with human PIOSCC.

[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.