Chondrosarcoma of the jaw bones: a review of 224 cases reported to date and an analysis of prognostic factors

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

BACKGROUND

Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field.

METHODS

In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication.

RESULTS

The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention.

CONCLUSION

As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.

Chondrosarcoma of the maxilla

A woman in her 70s reported to the outpatient department of our tertiary care hospital with chief complaints of painless swelling in the right cheek and palatal area. The patient was a known case of diabetes mellitus and hypertension on medications with controlled sugars and blood pressure. The swelling was 10×8 cm in size extending from right infraorbital region up to the lower mandible. CT demonstrated a permeative lytic pattern of bone destruction noted involving the hard palate and maxillary bone.Using the Weber Ferguson approach, a surgical resection was carried out under general anaesthesia. Resection included from right total maxillectomy (excluding roof of maxilla), nasal septum up to left medial maxillectomy including hard palate and the tumour was resected en bloc. The palatal obturator was fixed. On the basis of histopathology, grade 1 well-differentiated chondrosarcoma was diagnosed. The patient received postoperative radiotherapy and had a good recovery.

Update of Key Clinical, Histological and Molecular Features of Malignant Bone Tumours Arising in the Craniofacial Skeleton

The craniofacial skeleton is a highly complex and specialized anatomic region containing and protecting the brain and sensory organs. Bone sarcomas arising here comprise a heterogeneous group of tumours, some of which differ in their biological behaviour compared to their peripheral counterparts. The reasons for this seem to lie, at least partially, in the embryonal development of the craniofacial bones. For reaching the correct diagnosis as the cornerstone of optimal personalised treatment planning, a multidisciplinary team of specialists, including pathologists, radiologists, oncologists, and head and neck surgeons needs to be involved. The most common tumours arising in the craniofacial bones are bone-forming tumours, cartilage-forming tumours, fibro-osseous lesions, giant cell-rich lesions, and notochordal tumours. While morphology remains the backbone for the diagnosis, the last decade has witnessed tremendous advances in the molecular characterization of tumours, and molecular testing is increasingly becoming a part of the diagnostic process. The integration of these new molecular markers into the diagnostic approach has undoubtedly increased the diagnostic accuracy and objectivity, and holds great promise to also identify new therapeutic targets for precision medicine in the future. Examples include HEY1-NCOA2 in mesenchymal chondrosarcoma, IDH1/2 mutations in chondrosarcoma and TFCP2 rearrangements in rhabdomyosarcoma. In this article, key clinical, histological and molecular features of malignant bone tumours arising in the craniofacial region are discussed, with a special focus on the differential diagnosis and prognostic considerations.

Chondrosarcoma-from Molecular Pathology to Novel Therapies

Chondrosarcoma (CHS) is the second most common primary malignant bone sarcoma. Overall survival and prognosis of this tumor are various and often extreme, depending on histological grade and tumor subtype. CHS treatment is difficult, and surgery remains still the gold standard due to the resistance of this tumor to other therapeutic options. Considering the role of differentiation of CHS subtypes and the need to develop new treatment strategies, in this review, we introduced a multidisciplinary characterization of CHS from its pathology to therapies. We described the morphology of each subtype with the role of immunohistochemical markers in diagnostics of CHS. We also summarized the most frequently mutated genes and genome regions with altered pathways involved in the pathology of this tumor. Subsequently, we discussed imaging methods and the role of currently used therapies, including surgery and the limitations of chemo and radiotherapy. Finally, in this review, we presented novel targeted therapies, including those at ongoing clinical trials, which can be a potential future target in designing new therapeutics for patients with CHS.

Chondrosarcoma of the Temporomandibular Joint: Systematic Review and Survival Analysis of Cases Reported to Date

The purpose of this systematic review was to summarize the available data on TMJ chondrosarcomas and to perform a survival analysis of cases reported to date. This review was conducted in accordance with the PRISMA. Two authors performed an electronic search of case reports of TMJ chondrosarcoma published until August 02, 2020. Forty-seven studies reporting 53 cases were included. Chondrosarcomas of the TMJ were more prevalent in women, with a male:female ratio of 1:1.4. Survival curves were significantly associated with histological diagnosis (p = 0.004), reconstructive surgery (p = 0.024), recurrence (p < 0.001), and distant metastasis (p = 0.001). Only distant metastasis was independently associated with survival (p = 0.017). TMJ chondrosarcomas presented with low recurrence and higher survival rates than other chondrosarcomas. Synovial subtype, absence of reconstructive surgery, and presence of local recurrence or distant metastasis were associated with poorer prognosis.

Management of Chondrosarcomas of the Jaws in a Nigerian Tertiary Hospital

BACKGROUND

There is a dearth of literature on the diagnostic characteristics and treatment outcomes for chondrosarcomas of the jaws in our environment due to the rarity of the lesion.

OBJECTIVES

The aim of this study was to review the demographic data, presenting symptoms, location, radiographic findings, histological findings, treatment, and outcomes in chondrosarcoma of the jaws.

MATERIALS AND METHODS

A retrospective medical record review was undertaken of all patients diagnosed with chondrosarcoma of the jaws at our center between 2000 and 2020.

RESULTS

Ten patients (3%) were identified among 333 patients with orofacial neoplastic lesions. The mean age was 26.6 years (standard deviation [SD] 20.6 years, range 14-82 years). The male-to-female ratio was 1:1. Eight (80.0%) patients had jaw swelling and the average duration of symptoms on presentation was 18 months. Maxillary location occurred in six (60.0%) patients. Radiographically, all the lesions appeared radiolucent without clearly defined borders. All patients had only radical resection, except one who had adjuvant chemotherapy as well. Recurrence occurred in three (30.0%) patients and one of the patients died. The mean follow-up was 3 years (range 1-5 years).

CONCLUSIONS

Chondrosarcomas in this study affected relatively young patients, with painless jaw swelling being the most common presenting symptom. Men and women were equally affected. Radiolucent lesions and conventional histological types were the most common. Radical surgery alone was the most common modality of treatment and the outcomes were good.

Wide Anterior Maxillary Reconstruction with Equine Bone Xenograft: A Case Report of 24-Month Follow-Up

Introduction. Orofacial reconstruction plays an important role in the treatment of patients affected by oral and maxillofacial cancers. Improvements in technologies and studies of biomaterials have widely expanded surgical possibilities to achieve good functional and aesthetic outcomes. By the way, xenografting procedures gained great consensus in the last decades, because of their documented reliability and efficacy. We present a case of anterior maxillary chondrosarcoma (CHS) that has undergone surgical ablation followed by reconstruction with an equine-derived bone xenograft. Case Presentation. A 68-year-old woman affected by CHS of the premaxilla underwent surgical ablation involving the four incisors followed by reconstruction using an equine-derived bone substitute. Bony reconstruction was planned to achieve implant and dental prosthetic rehabilitation at a second surgical time. Primary surgery was carried out without complications. Good integration of the graft was confirmed by radiological examination. At 12-month follow-up, the patient refused the implant placement and spontaneously adopted a mobile prosthesis. One year later, plates and screws were removed, because of the exposure of a titanium plate. The graft was finally rejected within 3 weeks. Discussion. Nonantigenic equine-derived biomaterials have shown reliability and a good safety profile. In the presented case, implant insertion should have been performed 12 months after the primary surgery. During the follow-up, until dental mobile prosthesis was applied, clinical and instrumental examinations demonstrated a good integration of the graft. We suppose that a chronic inflammation of the mucosa led to the exposure of the plate, perhaps due to pressure, minimal movements, or imperfect fitting of the mobile prosthesis. Removal of fixation means was performed to prevent grafting failure, without success. On the other hand, missing load could induce the graft to act just like a prosthesis, without a real process of integration. Safety and reliability of equine-derived bone xenografts cannot be currently confirmed if not followed by implant insertion and dental rehabilitation.

Oral radiation-induced sarcomas: Systematic review

BACKGROUND

The aim of this study was to integrate the available data published on radiation-induced sarcoma of the oral cavity into an analysis of its clinical features, treatment modalities and prognostic factors.

METHODS

An electronic search was undertaken in September 2019. The eligibility criteria included publications that had enough clinical and histological information to confirm the diagnosis.

RESULTS

Forty-two publications with 122 radiation-induced sarcoma of the oral cavities (RISOCs) were included. The mean latency period was 114 months and mean radiation total dose was 62.5 Gy. The tumors were more prevalent in males between 50 and 60 years old and the mandible was the most affected site. Osteosarcoma was the most prevalent histological type and patients were mostly treated with radical surgery.

CONCLUSIONS

RISOC showed a poor survival rate of 15.1% in 5-year follow-up. Gender and histological type were independently associated with survival.

Primary maxillary chondrosarcoma: A case report

BACKGROUND

Sarcomas of the head and neck region are rare tumors, constituting less than 1% of malignant neoplasms in this area, of which few cases (20%) originate from bone or cartilage. Chondrosarcoma is a malignant neoplasm that develops in bone, with a predilection for the pelvis, chest wall, and scapula, and is uncommon in the maxilla and jaw. Although this type of lesion has locally aggressive behavior, destroying the affected bone, it can metastasize when it is not diagnosed early and compromise the patient's life.

CASE SUMMARY

On intraoral examination of a 32-year-old female with a tumor in the middle third of the face, a well-defined rise in volume of approximately 3 cm in diameter was observed. Computed tomography with 3-dimensional reconstruction was performed, and we observed that the osteolytic lesion affected the vestibular cortex as the palatal bone. Hematoxylin and eosin staining revealed an appearance that was similar to mature hyaline cartilage, hypercellularity, nuclear and cellular pleomorphism, and multinucleated cells, with significant vacuolization.

CONCLUSION

Determination of the clinical and histopathological characteristics of rare neoplasms in the maxillofacial region, such as chondrosarcomas, allows the pathologist and surgeon to make the appropriate therapeutic decisions, optimizing the patient’s prognosis.

Molecular findings in maxillofacial bone tumours and its diagnostic value

According to the WHO, mesenchymal tumours of the maxillofacial bones are subdivided in benign and malignant maxillofacial bone and cartilage tumours, fibro-osseous and osteochondromatous lesions as well as giant cell lesions and bone cysts. The histology always needs to be evaluated considering also the clinical and radiological context which remains an important cornerstone in the classification of these lesions. Nevertheless, the diagnosis of maxillofacial bone tumours is often challenging for radiologists as well as pathologists, while an accurate diagnosis is essential for adequate clinical decision-making. The integration of new molecular markers in a multidisciplinary diagnostic approach may not only increase the diagnostic accuracy but potentially also identify new druggable targets for precision medicine. The current review provides an overview of the clinicopathological and molecular findings in maxillofacial bone tumours and discusses the diagnostic value of these genetic aberrations.

Malignant maxillofacial bone tumors

PURPOSE OF REVIEW

Malignant bone tumors of the head and neck region are rare. Due to the paucity of studies on these tumors, patients with these maxillofacial malignancies can suffer from high morbidity and mortality.

RECENT FINDINGS

Currently, mainstay management of these tumors includes wide surgical resection with margins followed by radiotherapy and/or adjuvant chemotherapy. Although much progress has been made over the last few decades regarding the prognosis of many of these tumors, large multicenter trials are needed to better determine their optimal management.

SUMMARY

The current review will provide a broad review of the most current epidemiology, pathogenesis, prognosis, and management of the most common bone malignancies of the maxillofacial skeleton.