Osteogenic sarcoma of the jaw: a 10-year experience

Clinical and Pathological Features of Osteosarcomas of the Jaws: A Retrospective Study

INTRODUCTION

Osteosarcomas of the jaw (OSJs) are rare tumors with distinct characteristics from osteosarcomas affecting other bones. This study aims to analyze the clinical, pathological, and therapeutic characteristics of OSJs.

METHODS

A retrospective, descriptive cross-sectional study including patients diagnosed with OSJ registered at the "La Paz" University Hospital, Madrid, was performed.

RESULTS

Data of eight patients with a diagnosis of OSJ were obtained during the study period of 22 years (2002-2024). The mean age of the patients was 41 years. The distribution was 1:1 between the maxilla and mandible. Painful inflammation was the most frequent clinical manifestation. Conventional osteoblastic osteosarcoma was the most predominant histological type. Survival rate at 5 years was 50%, which decreased to 25% at 10 years.

CONCLUSIONS

OSJs differ from conventional osteosarcomas of long tubular bones. Surgery continues to be the mainstay of treatment. However, more studies are needed through which more standardized protocols can be proposed for adjuvant therapeutic management.

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.

The impact of surgical resection margins on outcomes for adults with head and neck osteosarcomas: A Canadian sarcoma research and Clinical Collaboration (CanSaRCC) study

OBJECTIVE

The aim of the study is to describe the factors that influence outcome in adults with head and neck osteosarcoma (HNO) with a specific focus on the margin status.

METHODS

Patients with a diagnosis of HNO between the years 1996-2021 were reviewed from the Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) Database. Baseline characteristics, pathology, treatment, and outcomes were analyzed. Univariable (UVA) and multivariable (MVA) Cox regression models were performed. 5-year locoregional control rate and overall survival (OS) were estimated using Kaplan-Meier method and Log-Rank test.

RESULTS

Of 50 patients with a median age of 40 years (range 16-80), 27 (54%) were male. HNO commonly involved the mandible (n = 21, 42%) followed by maxilla (n = 15, 30%). Thirteen (33.3%) had low-intermediate grade and 26 (66.6%) had high grade tumors. Three patients (6%) had negative resection margins (>5 mm), 24 (48%) had close margins (1-5 mm), 15 (30%) had positive margins (<1mm) and 7 (16%) had unknown margin status. In total, 39 (78%) received chemotherapy - 22 (44%) received neoadjuvant chemotherapy while 17 (34%) received adjuvant chemotherapy. A total of 12 (24%) patients received radiotherapy, of whom 8 (16%) had adjuvant and 3 (6%) had neo-adjuvant. Median follow-up time was 6.3 years (range 0.26-24.9). Disease recurred in 21 patients (42%), of whom 15 (30%) had local recurrence only, 4 (8%) had distant metastasis, and 2 (4%) had both local and distant recurrence. 5-year locoregional control rate and OS was 62% and 79.2% respectively. Resection margins <3 mm was associated with lower 5 years OS and locoregional control rate (Log-Rank p = 0.02, p = 0.01 respectively).

CONCLUSION

Osteosarcomas of the head and neck are rare and local recurrence remains a concern. Surgical resection with negative resection margins may improve survival, and a 3 mm resection margin threshold may optimize survival. Radiotherapy and/or chemotherapy should be considered in a multidisciplinary setting based on risk-features.

Clinical features and overall survival of osteosarcoma of the mandible

Osteosarcoma is the most common bone sarcoma and is typically found in the distal femur, proximal tibia, and proximal humerus. While several factors are known to influence survival, less is known regarding the influence of primary tumor location. This study describes the clinical features and prognosis of mandibular osteosarcoma. The SEER database was utilized to identify cases of mandibular osteosarcoma diagnosed between 2004 and 2015. Sex, age, grade, histological subtype, tumor size, tumor extension, presence of metastasis at diagnosis, and therapeutic intervention were determined. Osteosarcomas originating from other sites were assessed for comparison. There were 164 cases of mandibular osteosarcoma identified, representing 5.5% of all surveyed osteosarcomas. The 2-, 5-, and 10-year overall survival rates were 79.9%, 65.6% and 58.5%, respectively. Survival was worse for patients with older age, larger tumor size, metastatic disease, and absence of surgical resection. Compared to other sites, mandibular osteosarcomas were significantly smaller tumors and were far less likely to metastasize. Mandibular osteosarcoma manifested at an older age than the more common extremity osteosarcomas and presented with smaller tumors. Rates of metastasis of jaw osteosarcoma were much lower than osteosarcoma found in the extremities, while mortality rates were comparable.

Osteosarcoma of the mandible: A case with a clinical appearance similar to benign lesions

A 34-year-old woman with complaints of mandibular swelling that started 4 months earlier was referred to the Oral Diseases Department. Based on the clinical and radiographic appearance, the primary diagnosis was an intraosseous reactive lesion. However, the result of histopathology indicated osteosarcoma.

Systematic review of craniofacial osteosarcoma regarding different clinical, therapeutic and prognostic parameters

Background

Osteosarcomas are the most common primary bone tumor while occurrence in the craniofacial skeleton is relatively rare. There are clinical differences of osteosarcomas regarding their location. In this regard craniofacial osteosarcomas (COS) have special characteristics. Extracranial osteosarcomas (EOS) occur mainly in the long bones of the extremities (tibia, humerus and femur). These tumors metastasize hematogenically at a very early stage. In comparison, COS are mainly localized in the mandible and maxilla, occur later in life and show significantly less and later metastasis and respond differently to adjuvant therapy. In the literature, clinical characteristics of COS and EOS are rarely compared directly. The aim of this systematic review is to answer the question whether COS and EOS exhibit fundamentally different clinical behavior and how they differ in terms of survival rates and response to different therapies.

Methods

A systemic review was performed. Pubmed, Cochrane and Google Scholar were used as search engines. The literature research was done by using clearly defined terms and their links. 124 full texts were selected and evaluated for this review. The inclusion criteria were determined using the PICO model.

Results

COS have significantly better survival rates, especially if they are located in the jawbone. Surgical R0 resection is crucial for therapeutic success. The study situation regarding the benefit of neoadjuvant chemotherapy in COS is very inhomogeneous. There is also no evidence for the benefit of adjuvant radio- or chemotherapy in COS. The large heterogeneity of the studies in terms of therapeutic concept, initial situation of the patients and outcome considered, as well as the small number of patients with craniofacial osteosarcoma were limiting factors.

Conclusion

The results of this study show the clear therapeutic and prognostic differences between COS and EOS and underline the necessity to consider both types of osteosarcoma as independent tumor entities in future studies. Furthermore, the study highlights the importance of surgical R0 resection for the prognosis of COS patients. There is no evidence for therapeutic benefit of adjuvant/neoadjuvant radio-/chemotherapy in R0 resected COS cases.

Malignant tumours mimicking periapical lesions: A report of three cases and literature review

Apical periodontitis shows radiographic signs such as widening of the periodontal ligament and periapical radiolucency, which differ in extent depending on the stage of the lesion. However, other lesions can be associated with or coincidental to the apical region, representing developmental lesions and benign or malignant tumours. This article describes three cases of malignant tumours, a central mucoepidermoid carcinoma (CMEC), a chondroblast osteosarcoma and an osteosarcoma of the jaw (OSJ) that presented as periapical lesions. Endodontists must be aware of unsuccessful treatment, persistent pain, signs of paraesthesia, a rapid growth rate and delayed response to therapy associated with atypical features. Complementary examinations, such as biopsy and computed tomography, can allow the early diagnosis of malignant tumours, leading to a better prognosis and thus increased survival rates and improvement in quality of life.

Malignant Sarcomatous Degeneration of Craniofacial Fibrous Dysplasia

BACKGROUND

Fibrous dysplasia (FD) is an uncommon bone disease characterized by the replacement of normal bone architecture with abnormal fibro-osseous connective tissue. Here, we discuss 2 cases of craniofacial FD, with malignant sarcomatous degeneration - a rare and morbid complication of the disease.

CASE HISTORY

Two cases of craniofacial FD with malignant degeneration are presented. In the first, a 68-year-old male with a history of FD presented with acutely worsening left-sided facial pain and V2 and V3 hypoesthesia. Imaging findings suggested a large infratemporal fossa mass with biopsy demonstrating sarcomatous degeneration. Radical craniofacial resection achieved a gross total resection with likely microscopic disease. The patient was unable to tolerate adjuvant chemotherapy or radiation and succumbed to his disease 13 months following surgery.In the second case, a 36-year-old male with McCune-Albright Syndrome and craniofacial FD presented with acutely worsening left-sided headaches and midface hypoesthesia. Imaging revealed a heterogenous and expansile lesion with erosive changes in the left nasal cavity and infratemporal fossa. Pathology was suggestive of low grade sarcomatous degeneration. Given the extensive involvement of the skull base, the tumor was deemed unresectable, and the patient soon died following initiation of chemotherapy.

CLINICAL RELEVANCE

Malignant sarcomatous transformation is a rare and challenging complication of craniofacial FD. Indolent onset, advanced spread at time of presentation, and close relationship with vital neurovascular structures are all hurdles for the treating clinician. The entity poses a diagnostic dilemma, as pathological analysis can be equivocal and may mimic nonmalignant processes, such as locally aggressive FD.

Osteosarcoma of the jaws: Report of 3 cases with emphasis on the early clinical and radiographic signs

Osteosarcoma is the most common primary malignancy of the jaws and is treated by radical surgical resection. Early detection is crucial because removing the lesion with clean margins contributes most to the outcome. We present 3 cases of osteosarcoma occurring in the interradicular region of the mandible, 2 of which were thought to represent nonmalignant processes upon initial presentation. All 3 demonstrated early but significant clinical and radiographic features indicative of the malignant disease process. Radiographically, these cases had in common unilateral periodontal ligament (PDL) space widening, displacement of teeth, and growth of the crestal bone. Clinically, all 3 cases presented with a painless intraoral swelling. Case 1: a 20-year-old African American man presented with swelling and loose teeth with a duration of 1.5 months. Histopathologic diagnosis of osteoblastic osteosarcoma, high grade, was made. Case 2: a 75-year-old White man presented with a 2 × 2 cm expansile lesion with a duration of 2 months. Histopathologic diagnosis of chondroblastic osteosarcoma was made. Case 3: a 63-year-old White woman presented with a 5- to 6-mm lesion with a duration of at least 1 month. Histopathologic diagnosis of chondroblastic osteosarcoma was made. All 3 cases were treated with wide surgical resection.

SATB2 is not a reliable diagnostic marker for distinguishing between oral osteosarcoma and fibro-osseous lesions of the jaws

OBJECTIVE

Special AT-rich binding protein 2 (SATB2) is an immunohistochemical marker for osteoblast differentiation. Our aim was to investigate SATB2 expression in oral osteosarcoma and other bone-producing oral tumors/reactive lesions to evaluate its usefulness as a diagnostic marker.

STUDY DESIGN

A total of 74 intraosseous and soft tissue bone-producing surgical samples and 10 samples of reactive bone tissue were stained with SATB2, including osteosarcoma/chondrosarcoma (n = 16), fibro-osseous lesions (n = 42), central giant cell granuloma (n = 6), osteoblastoma (n = 1), and gingival lesions (n = 9). Nuclear labeling of the stromal spindle cells and intensity of staining was scored and analyzed.

RESULTS

The intraosseous (n = 65/65) and soft tissue samples (n = 9/9) diffusely expressed SATB2. The strongest expression was observed in juvenile aggressive ossifying fibroma (n = 2/2). Weak SATB2 expression was observed in the stromal spindle cells adjacent to reactive bone tissue (periosteal bone reaction).

CONCLUSIONS

Our results indicate that SATB2 is not a reliable diagnostic marker for oral osteosarcoma but has practical use in detecting cells with osteoblast differentiation in histologic samples with scant bone production or in differentiating between a periosteal bone reaction and neoplastic bone induced by the tumor mesenchymal cells. Targeting SATB2 as an alternative therapy in oral osteosarcoma, fibro-osseous lesions, and central giant cell granuloma should be further investigated.

Osteosarcoma of the jaw: report of 3 cases (including the rare epithelioid variant) with review of literature

Osteosarcoma of the jaw (OSJ) is a rare malignancy, accounting for less than 1% of head and neck malignancies. OSJ can arise as a primary malignancy or secondary to locoregional radiation treatment. Radiologically, these tumors show large, destructive growth with periosteal reaction, which can suggest the diagnosis of osteosarcoma (OS). However, histology with demonstration of neoplastic, "lacelike" osteoid is the key to determining the diagnosis. Small tissue samples can complicate the diagnosis, especially in cases of high-grade OS with sheetlike growth and scant areas of immature osteoid formation. We report 3 cases of OSJ, including 1 rare case of epithelioid OS of the mandible, diagnosed at our hospital over a 6-month period: case 1: a 48-year-old male with history of Hodgkin lymphoma, who was treated with radiation and developed osteoblastic OS of the mandible 14 years later; case 2: a 79-year-old female with a history of fibrous dysplasia, who presented with a large destructive maxillary mass, which was diagnosed as histologically fibroblastic OSJ of the maxilla; and case 3: a 70-year-old male with radiation-induced high-grade epithelioid OS, which had been incorrectly diagnosed as poorly differentiated squamous cell carcinoma on a small biopsy specimen; this patient experienced recurrence with multiple neck nodules after treatment, underwent repeat resection, and was finally diagnosed with high-grade OS (epithelioid type).

The Utility of MDM2 and CDK4 Immunohistochemistry and MDM2 FISH in Craniofacial Osteosarcoma

Craniofacial osteosarcoma is rare (2-10% of all osteosarcomas). Most low grade fibroblastic osteosarcomas of the long bones are characterized by amplification of chromosome12q including MDM2 and CDK4 genes. This study aims to investigate the utility of MDM2 and CDK4 immunostains as well as MDM2 FISH in craniofacial osteosarcomas as a means of distinguishing them from benign fibro-osseous lesions. Cases of primary osteosarcoma and benign fibro-osseous lesions of the craniofacial bones were identified in the diagnostic pathology archives. MDM2 (SMP14 and/or IF2) and CDK4 (D9G3E and/or DCS-31) immunostains were performed on a representative block from each osteosarcoma and benign case. Fluorescence in situ hybridization (FISH) for MDM2 was performed on non-decalcified osteosarcomas. In osteosarcomas, the rate of expression of either MDM2 IF2, MDM2 SMP14, CDK4 DCS-31, or CDK4 D9G3E was 72.7% (8/11 cases), usually focal and weak. Using the MDM2 IF2 clone and the CDK4 DCS-31 clone, MDM2 and CDK4 were negative in lesional cells in all 14 benign fibro-osseous lesions. Using the IF2 and SMP14 clones, MDM2 nuclear expression was present in associated osteoclast-like giant cells in both benign and malignant cases. Of 4 successful cases, 1 high grade osteosarcoma was positive for MDM2 amplification. MDM2 or CDK4 expression or MDM2 amplification may aid in a diagnosis of head and neck osteosarcoma. However, when absent, sarcoma is not excluded. Due to focal weak expression of MDM2 in tumor cells in conjunction with nuclear expression in associated giant cells, caution should be exercised when interpreting positive stains.

Soft Tissue Special Issue: Gnathic Fibro-Osseous Lesions and Osteosarcoma

Gnathic fibro-osseous lesions are a diverse group of disease processes which share overlapping microscopic features characterized by fibroblastic stroma with variable cellularity and a range of bone forming pathological processes leading to woven, sclerotic and cementum-like structures. Some of the lesions are unique to craniofacial location and a combination of clinical, radiological and pathological correlation is often necessary for diagnostic accuracy. Gnathic osteosarcomas are rare tumors with differences in age distribution and behavior as compared to osteosarcoma of long bones. This review will discuss the clinicopathological and radiological features of gnathic fibro-osseous lesions and osteosarcoma with updates on current genetics and molecular pathogenesis.

Adolescent and Young Adult Oral Maxillofacial Tumors: A Single-Institution Case Series and Literature Review

Adolescent and young adult (AYA) oral maxillofacial tumors are rare and account for ∼12% of all AYA cancers. Due to the low incidence of these malignancies, diagnostic considerations, therapeutic approaches, and factors affecting prognosis have been difficult to characterize. Given the anatomic structures located within the head and neck, patients are at risk for treatment-related morbidity that may adversely impact their quality of life. We present a single-institution case series of AYA patients with oral maxillofacial tumors treated at the University of Illinois at Chicago. A multidisciplinary treatment approach, including collaboration with the Oral Maxillofacial Surgery, Dentistry, and the Ear, Nose, and Throat teams along with the utilization of Children's Oncology Group treatment protocols, can serve as a model to address the challenges in the management of these complex cases.

Craniomaxillofacial osteosarcoma - The role of surgical margins

BACKGROUND

Osteosarcomas (OS) in the craniomaxillofacial (CMF) region are typically diagnosed at later age than long-bone OS, but they are reported to have better 5-year survival. Curative treatment warrants wide surgical resection, which is often not possible in the CMF region. The purpose of this article is to present a nationwide series of CMF in Finland to discuss the role of surgery.

PATIENTS AND METHODS

All 21 CMF OS patients managed in Finland from 1992 to 2009 were included. The mean age was 40 years (range 15-72). Data on patient and tumor characteristics, treatment modalities, and survival were recorded. All patients had a minimum follow-up of 5 years or until death.

RESULTS

OS was evenly represented in the mandible and maxillary bones, which together constituted 76% of all sites. Surgery with curative intent was carried out in 20 patients. Clear margins were achieved in only five cases. Eight (40%) of these 20 patients died due to OS, and their average survival time was 1.3 years. Seven (35%) out of the 20 patients received radiotherapy due to close/intralesional surgical margins, and four of them did not develop recurrences during the follow-up.

CONCLUSIONS

The results suggest that postoperative radiotherapy may alter the prognosis in CMF OS, particularly in cases with close or intralesional margins. This may increase the survival rates achieved by prompt action in performing radical surgery.

A modified preauricular and transmandibular approach for surgical management of osteosarcoma of the mandibular condyle within the masticator space and infratemporal fossa: a case report

Background

Osteosarcomas of the head and neck region are rare entities that comprise < 10% of all osteosarcomas. Multimodality treatment of patients with osteosarcoma is well-established for osteosarcoma in long bones, and the benefits of chemotherapy in long bones are clearly known. However, there is no consensus regarding the effects of chemotherapy in cases of head and neck osteosarcoma. The prognostic factor for head and neck osteosarcoma is complete tumor resection with negative margin, which is a radical surgery. However, a clear margin may be difficult to achieve in the head and neck region.

Case presentation

We present a case of a 69-year-old Japanese woman who developed osteosarcoma of the condyle within the masticator space and infratemporal fossa, which was treated with radical surgery using a modified preauricular and transmandibular approach. Although we recommended adjuvant treatment after surgery, the patient refused this treatment. There was no evidence of local recurrence or distant metastasis through 30 months of follow-up.

Conclusions

Our modified preauricular and transmandibular approach allowed access to the masticator space and infratemporal fossa, thereby increasing complete resection of the tumor and resulting in minimal functional and cosmetic deficits.

Young Adult With Osteosarcoma of the Mandible and the Challenge in Management: Review of the Pediatric and Adult Literatures

Neoadjuvant chemotherapy for osteosarcoma of the jaw (OSJ) remains controversial despite being a standardized treatment in osteosarcoma of the long bones. We present a case of a 22-year-old male with OSJ and performed a retrospective systemic review of previously published literatures of OSJ. We identified 27 articles: 7% recommended neoadjuvant chemotherapy, 22% recommended adjuvant chemotherapy, 19% recommended both neoadjuvant and adjuvant chemotherapy, 33% recommended against chemotherapy and 19% stated the role of chemotherapy is unknown. The lack of consensus regarding the use of chemotherapy in OSJ, despite its benefits, demonstrates the need to establish a standardized algorithm for OSJ.

Prognosis of osteosarcomas in the mandible: 15-year experience of 55 patients

Our goal was to evaluate the prognosis of osteosarcomas (OS) in the mandible for finding out the best treatment.Patients diagnosed with OS in the mandible from January 2000 to December 2015 were retrospectively enrolled. Demographic, tumor-specific, treatment, and survival data were collected and analyzed.A total of 55 patients (35 male and 20 female) were included, all patients had first manifestation of swelling. Cachexia occurred in 15 (27.3%) patients. Chondroblastic type was the most common histology subtype followed by osteoblastic type. High grade tumors were found in 30 (63.6%) patients. 33 (60%) patients received an operation of hemimandibulectomy, and free fibula reconstruction was performed in 20 (36.4%) patients. The 5-year recurrence-free survival (RFS) and disease-specific survival (DSS) rates were 73.6% and 66.9%, respectively. Univariate prognostic analysis reported risk factors of tumor grade, reconstruction type (free fibula flap vs non-free flap), and operation extent were significant for the recurrence, and reconstruction type and operation extent were significant for the disease-specific death, but in multivariate analysis, only the factor of operation extent was significantly associated with both the recurrence and death.A wide excision extent such as hemimandibulectomy is suggested for OS in the mandible for achieving good prognosis.

Osteosarcoma of the jaw - experience at the Medical University Vienna and comparative study with international tumor registries

OBJECTIVES

Osteosarcoma of the jaw (OSAJ) is fundamentally different in clinical practice from its peripheral counterparts. Studies are difficult to conduct due to low incidence rates. The primary aim of this study was to provide for the first time a comprehensive retrospective analysis of the treatment concepts and outcome data of OSAJ patients treated at the University Hospital Vienna and to compare these with two recently published studies on OSAJ. The clinical study was accompanied by a biomarker study investigating the prognostic relevance of melanoma-associated antigen-A (MAGE-A) in OSAJ specimens.

METHOD

Eighteen patients were included, and their outcomes were compared to published data. Immunohistochemistry was performed with mouse monoclonal antibodies against MAGE-A. Survival rates were estimated by the Kaplan-Meyer method. The log-rank test was used to analyze potential prognostic parameters. Fisher's exact test was performed to define the significant differences between the survival rates of the current study and the DOESAK registry.

RESULTS

Disease-specific survival was 93.8% after five and 56.3% after ten years. The development of metastases (p=0.033) or relapse (p=0.037) was associated with worsened outcomes in our group as well as in the comparative group. Despite the different treatment concepts of the study groups, survival rates were comparable. MAGE-A failed to show prognostic relevance for OSAJ patients.

CONCLUSIONS

Uncertainties about the optimal treatment strategies of OSAJ patients will currently remain. Thus, prospective studies of OSAJ are needed but are only feasible in a multicenter study setting, conducted over a prolonged time period.

Malignant Transformation of Ossifying Fibroma into Parosteal Osteosarcoma with High-grade Component: Presentation of an Unusual Case and Review of the Literature

Background:

Parosteal Osteosarcoma of the Jaw (POSJ) is a rare entity that is associated with a high survival rate. Several case reports and case series of POSJ have been published in the literature, but few authors have described development of this tumor by possible transformation from a fibro-osseous neoplasm.

Objective:

We present a rare occurrence of parosteal osteosarcoma with involvement of the posterior maxilla, orbit floor, and infra-temporal fossa in a 20-year-old man. Furthermore, we performed a literature review regarding clinical, radiological, and histological features; treatment strategies; and etiology/pathophysiology.

Methods:

A PubMed search yielded a total of 74 articles and the articles were sorted according to their corresponding key area of focus.

Results:

This was a case of POSJ with high-grade component in the maxillofacial region of a 20-year old male. Co-expression of MDM2 and CDK4 was confirmed. At 2.5-year follow-up, the patient had died. The literature review revealed 18 articles including 20 cases of POSJ. Four cases represent the possible development of this tumor by transformation from a fibro-osseous neoplasm: Two cases of fibrous dysplasia, one case of cemento-ossifying fibroma, and the case of Ossifying Fibroma (OF) in the present study.

Conclusion:

In conclusion, we found an unusual case of POSJ of the midface in a patient with a previous diagnosis of OF in the same region. To our knowledge, there have been no previous reports of development of POSJ in OF. Furthermore, this is the first described case of high-grade surface osteosarcoma in the craniofacial region.

Atypical Presentation of a Maxillary Chondroblastic Osteosarcoma and Complex Management

We report a rare case of a 23-year-old male who presented with a four-week history of unilateral recurrent epistaxis and nasal obstruction. This was subsequently diagnosed as high-grade chondroblastic osteosarcoma of the maxillary antrum. Neo-adjuvant chemotherapy was commenced following a multidisciplinary team discussion. The disease progressed through first-line treatment. A radical surgical resection was not possible, and a palliative debulking procedure was performed. The literature comprehensively points towards an early surgical resection with suitable margins at the earliest possible stage. This case highlights that osteosarcoma of the maxilla can be challenging to diagnose and manage. Thus, a high index of suspicion and an early referral to a head and neck specialist is imperative to improve the long-term prognosis in such patients.

Prognostic factors to survival of patients with chondroblastic osteosarcoma

This study was aimed to reveal the changes in survival rates and prognostic factors to survival of chondroblastic osteosarcoma (COS).Patients from the Surveillance, Epidemiology, and End Results (SEER) database were retrieved. Kaplan-Meier survival analysis and Cox proportional hazard model were used during analysis.There were significant differences on overall survival between subtypes of osteosarcoma (P < .001*). Overall survival of COS did not change significantly during last forty years (P = .610), and cancer-specific survival increased to a plateau in 1980s and then remained stable (P = .058). Younger onset age, patients of white race, well and moderately differentiated tumors, and surgery independently predicted better overall (Hazard ratio [HR]: 1.034, P < .001*; HR: 0.538, P = .004*; HR: 0.240, P = .020* and HR: 0.350, P < .001*, respectively) and cancer-specific (HR: 1.031, P = .002*; HR: 0.592, P = .036*; HR: 0.098, P = .027* and HR: 0.253, P < .001*, respectively) survival. Metastasis at diagnosis independently predicted worse overall (HR: 3.108, P < .001*) and cancer-specific (HR: 4.26, P < .001*) survival compared to no metastasis.Younger onset age, white race, well and moderately differentiated tumors, no metastasis at diagnosis and surgical resection can independently predict better overall and cancer-specific survival of COS.

Osteosarcoma of the jaws in Koreans: analysis of 26 cases

Objectives

In order to assess clinical behavior, response to treatment, and factors influencing prognosis of Korean patients with osteosarcoma of the jaws (OSJ).

Materials and Methods

A retrospective study of clinical, and pathological records of 26 patients with OSJ treated at the Department of Oral and Maxillofacial Surgery in Yonsei University Dental Hospital from 1990 to March 2017.

Results

Of 26 patients, there were 9 men (34.6%) and 17 women (65.4%). Twenty-one of 26 patients had osteosarcoma of the mandible, and 5 of 26 patients had osteosarcoma of the maxilla. The histopathology of OSJ is highly variable, ranging from chondroblastic type (6 out of 26), osteoblastic type (10 out of 26), fibroblastic type (2 out of 26), to the rare variants like mixed type, small cell osteosarcoma types and more. All patients underwent gross total excision and only a few patients underwent neoadjuvant chemotherapy. Postoperative chemotherapy was given to most of the patients as adjuvant treatment or in combination with radiotherapy. The overall survival rate was 73.1% with an overall 2-year survival rate of 83.3%. The overall 5-,10-,15-year survival rates in this study were 73.5%, 73.5%, 49%, respectively. Using Kaplan-Meier analysis with log rank tests, the size of tumor (T-stage), and resection margins were found to affect the survival rate significantly. The chemotherapy was not significantly associated with improved survival rate.

Conclusion

Surgical resection with a clear margin is the most important factor in disease survival. The role of chemotherapy and radiotherapy in OSJ remains controversial, and deserves further studies.

Chondroblastic osteosarcoma mimicking periapical abscess

Lesions of non-endodontic origin may mimic periapical abscess. Osteosarcoma is a rare malignant lesion.

Conventional osteosarcoma of the mandible successfully treated with radical surgery and adjuvant chemotherapy after responding poorly to neoadjuvant chemotherapy: a case report

Background

Osteosarcoma, the most common primary bone malignancy, has an extremely poor prognosis and a high rate of local recurrence and distal metastases. Because osteosarcomas of the head and neck region are rare, accounting for less than 10% of all osteosarcoma cases, limited information is available about their treatment and prognosis. Because of the high rate of distal metastases associated with extragnathic osteosarcoma, surgery combined with chemotherapy is currently considered essential in its treatment. However, the role of chemotherapy has not been well elucidated in the treatment of head and neck osteosarcoma because of the rarity of this condition.

Case presentation

In this report, we present the case of a 58-year-old Japanese woman with osteosarcoma of the mandible that was treated with radical surgery combined with neoadjuvant and adjuvant chemotherapy. Because the tumor showed rapid growth during neoadjuvant chemotherapy, neoadjuvant chemotherapy was suspended and surgical resection was performed, followed by adjuvant chemotherapy. No evidence of local recurrence and distal metastasis was found 14 months after initial treatment. Local control is considered a principal prognostic factor for head and neck osteosarcoma.

Conclusions

Wide surgical excision should be considered a primary goal even during neoadjuvant chemotherapy, especially in cases that respond poorly to neoadjuvant chemotherapy.

Multimodal treatment of craniofacial osteosarcoma with high-grade histology. A single-center experience over 35 years

High-grade craniofacial osteosarcoma (CFOS) is an aggressive malignancy with a poor prognosis. Our goals were to evaluate treatment outcomes in those treated at a single referral institution over 35 years and to compare our results to the available literature. A retrospective analysis of all 42 patients treated between 1980 and 2015 at Oslo University Hospital, Norway, identified in a prospectively collected database, was conducted. Mean follow-up was 79.6 months. Overall survival at 2 and 5 years was 70.5 and 44.7%, respectively. The corresponding disease-specific survival rates were 73.0 and 49.8%. Treatment was surgery only in eight cases. Additional therapy was administered in 34 patients: chemotherapy in nine, radiotherapy in seven, and a combination of these in 18 cases. Stratified analysis by resection margins demonstrated significantly better survival at 2 and 5 years after radical surgical treatment. Neoadjuvant chemotherapy and subsequent adequate surgery resulted in better survival than surgery alone. Half of the patients either had a primary or familial cancer predisposition. This is the largest single-center study conducted on high-grade CFOS to date. Our experience indicates that neoadjuvant chemotherapy with complete surgical resection significantly improved survival, compared to surgery alone.

Osteosarcoma of the Mandible: A Site-Specific Study on Survival and Prognostic Factors

Osteosarcoma of head and neck is a rare condition comprising of <1% of all head and neck cancers, retrospective studies show difference in survival of mandibular osteosarcoma to other head and neck sites, necessitating investigation into site-specific survival and recurrence rates.

Epidemiological Evaluation of Head and Neck Sarcomas in Iran (the Study of 105 Cases Over 13 Years)

Background:

Head and neck sarcomas are exceedingly rare and they include 4% - 10% of all sarcomas and less than 1% of all neoplasm of head and neck.

Objectives:

The aim of this study is to evaluate the epidemiological characteristics of head and neck sarcomas of patients in Isfahan, Iran.

Patients and Methods:

In this retrospective study, from the 16000 patients whose files were evaluated, the total number of 105 head and neck sarcomas were collected. They were evaluated with due attention to age, gender of the patients and the most common location of the lesion.

Results:

From the total number of 105 (0.6%) patients with sarcomas, 56 were men (53.33%) and 49 women (46.66%). The most common head and neck sarcomas among this population were Osteosarcoma (32 cases, 30.47%), Chondrosarcoma (14 cases, 13.33%), and Ewing sarcoma (11 cases, 10.47%).The most common soft tissue sarcoma was Rabdomiosarcoma. Mandible was the most common location for these lesions.

Conclusions:

In this study, the hard tissue sarcomas were more prevalent than soft tissue ones. Hence, special attention should be paid to the patients when being diagnosed.

Collision tumor of maxilla: a diagnostic dilemma

Most malignant tumors arise from the primary tissue except when showing extreme dedifferentiation. This can be identified by examination of tumor cells and their products. Occasionally two distinct tissues are recognized within a malignant tumor. In mixed malignant tumors both carcinomatous and sarcomatous elements are present either because of simultaneous malignant change occurring in the epithelium and its nonepithelial stroma or there is a sarcomatous transformation of stroma of a carcinoma. Willey's in 1960 stated that in these circumstances the resulting tumor must be classified as a "carcino-sarcoma". These separate tumors arise in nearby structures and may grow to infiltrate in each other resulting in a tumor mass. The present article is a report of a diagnostic dilemma in an extremely rare carcinosarcoma of maxilla in a 24 year old male which was first on biopsy reported as odontogenic myxoma. After resection (right maxillectomy under GA using Weber Fergusons approach with Diffenbach's extension) was diagnosed as Squamous Cell Carcinoma arising from lining of the maxillary antrum associated with Osteogenic Sarcoma (chondroblastic differentiation) of maxilla with negative margins. The tumor was restaged to T2NoMx and further managed as per National Comprehensive Cancer Network Guidelines. Immunohistochemistry later re-diagnosed it to be an Osteogenic Sarcoma maxilla with chondroblastic differentiation. 'T' stage remains the most reliable predictor of survival and loco-regional control. Complete surgical resection for all 'T' stages (except T4b, any N) followed by postoperative therapy remains a corner stone of treatment of maxillary sinus tumors.

Malignant transformation in monostotic fibrous dysplasia: clinical features, imaging features, outcomes in 10 patients, and review

Malignant transformation in fibrous dysplasia (FD) is uncommon. The purpose of this study was to investigate clinical and imaging features, and outcomes of malignant transformation in monostotic FD.Data for 10 pathologically confirmed malignant transformations in monostotic FD from January 2005 to December 2013 were retrospectively reviewed. Patient data were recorded, and radiographs (n = 10), computed tomography (CT) (n = 5), magnetic resonance (MR) (n = 4), and bone scintigrams (n = 10) were evaluated for lesion location, margin, cortical destruction, marrow involvement, periosteal reaction, and soft tissue mass by 2 musculoskeletal radiologists with agreement by consensus. Clinical features, management, and prognosis were also analyzed for each of the 10 cases.There were 8 male and 2 female patients (mean age 46.5 ± 15.9 years). The affected sites were the femur (n = 4), humerus (n = 2), tibia (n = 3), and ilium (n = 1). Five cases had received previous surgery and 5 cases had no history of surgery. No patients had been given prior irradiation treatment. For the 5 cases with surgery, radiographs and CT showed purely osteolytic lesions with poor margination in the curettage area (n = 5), cortical destruction (n = 5), obvious soft tissue mass (n = 1), and mineralization (n = 2). For the 5 cases without surgery, radiographs and CT identified poorly marginated, osteolytic lesions within or near the area with "ground-glass" opacity (n = 4), cortical erosion (n = 4), and mineralization (n = 2). Magnetic resonance imaging (MRI) also identified lesions with heterogeneous signal intensity and pronounced enhancement. Bone scintigraphy revealed eccentric increased uptake of radionuclide in monostotic lesion (n = 10). Pathology reports revealed osteosarcoma (n = 7), fibrosarcoma (n = 2), and malignant fibrous histiocytoma (MFH) (n = 1). At the end of the study, 1 patient died from tumors, 1 patient was alive with lung metastasis, 1 patient experienced recurrence, and 7 patients were alive without recurrence.Patients with FD and a history of surgery should be followed up, for the osteolytic lesions in the operative areas strongly indicate the malignant transformation. The radiographic feature of FD-related malignancies is poorly marginated, mineralized, and osteolytic lesions with cortical destruction. Further investigations are needed to explore the pathogenesis of malignancies in FD and to establish optimal therapeutic strategies.

Unusual presentation of extranodal diffuse large B-cell lymphoma in the head and neck: description of a case with emphasis on radiographic features and review of the literature

A very unusual radiographic presentation of non-Hodgkin lymphoma (NHL) involving the maxilla is described. The patient was initially managed with antibiotics prescribed to treat what was thought to represent an odontogenic infection. After unsuccessful antibiotic therapy, the patient was referred to an oral surgery clinic where CBCT was performed. CBCT revealed an atypical generalized sclerosis of the affected bone rather than the usual lytic radiographic pattern associated with NHL. Destruction of the sinus floor with infiltration of the sinus was also present. This rare radio-opaque radiographic presentation is described in detail together with the clinical presentation and histopathological findings. The important radiographic features suggesting malignancy that were present in this atypical case of NHL are discussed. A differential diagnosis highlighting the differences between NHL, osteomyelitis and osteosarcoma is also provided.

Osteosarcomas of jaw: experience of a single centre

Although osteosarcoma is the most common primary malignant tumour of bone, osteosarcomas of jaw are rare. In osteosarcomas of jaw, evaluating the clinicopathological factors affecting the prognosis is not easy because of different approaches to diagnosis, treatment, and follow-up. This study reviewed 14 cases of JOS that were diagnosed between 1990-2010, in terms of age, gender, site, clinical history, histopathologic type and histopathologic grade, treatment, and prognosis. Median age was 35 years, while male:female ratio was 1.8:1. Eight tumours were located in the mandible. Osteoblastic differentiation was the predominant feature in seven cases followed by chondroid osteosarcoma (four cases), fibroblastic osteosarcoma, low-grade (parosteal) osteosarcoma associated with fibrous dysplasia, and postradiation osteosarcoma (one cases each). During follow-up, recurrence was seen in four patients at least once and they all died. In conclusion, early diagnosis and complete resection seems to be effective in prognosis. Therefore, clinicians and pathologists should be aware of its characteristics and main differential diagnosis to avoid late recognition.

Massive recurrent chondroblastic osteosarcoma of maxilla: a rare case report

The jaw bones are particularly difficult to manage because of their proximity to important structures and later limited options in the rehabilitation of their form and functional factors. This stands true especially in cases of maxilla as being situated in a very peculiar anatomic location, comprising of the skull base and its related structures, any radical treatment is deferred. In order to retain the maximum form and function as later there are few reconstruction options available for maxilla the trend always goes in favour of least morbid treatment option whether being surgery, chemotherapy or radiation therapy. Moreover in maxilla the anatomic complexities makes it very difficult to get wide and clear surgical margins which again accounts for a poor prognostic rate. Recurrences are common in osteosarcomas of maxilla and the line of treatment for recurrence is still a matter of research.

Incidence and grading of cranio-facial osteosarcomas

Osteosarcoma of the cranio-facial structures and skull is rare. In children, only 5.6% of cases are localized in these areas. It is claimed that the mean age at presentation is at least 10-15 years higher than for osteosarcomas in other parts of the body. However these reports are based on data from single institutions or compiled from several registries. It is further claimed that tumours in the mandible and maxilla are less malignant, as based on observations of a better prognosis and lower incidence of metastatic spread as compared with osteosarcomas arising elsewhere. We report all histologically proven cranio-facial osteosarcomas in The Netherlands occurring over a 20-year period, based on the national registration covering all Dutch pathology laboratories (PALGA). The age-corrected incidence of primary osteosarcoma ranged from 0.33 to 0.41 per million across the age ranges. The mandible was the most frequent site of involvement. Only 61% had a high malignant histological grading. Our data indicate that the age-corrected incidence of primary osteosarcomas is similar across all age ranges. In respect to histology, a lower grade of malignancy is more frequent. Maxillary lesions significantly more often have a lower histological grade of malignancy.

Osteosarcoma of the maxilla: a rare case with unusual clinical presentation

Osteosarcoma (OS) is a malignant mesenchymal tumor, which rarely occurs in the maxilla. Although variable histologic and radiographic features of OS have been reported previously, in the majority of the cases painful swelling of the jaw is mentioned as the first clinical presentation. Furthermore, early diagnosis and wide surgical resection of the tumor are the most important determinant factors of prognosis. Therefore, the unusual clinical presentations of OS should be considered meticulously to expedite the diagnosis process. We describe a case of OS of the maxilla with extremely unusual presenta-tion in a 42-year-old female, that was initially designated as “epulis fissuratum”. Here, we highlight the importance of com-bining the clinical, radiographic and histopathologic examination to obtain a definitive diagnosis and also the significance ofearly effective surgical intervention in evaluation of pathologic lesions.

Osteosarcoma of the jaw: an analysis of a series of 74 cases

AIMS

To analyse a series of cases of osteosarcoma of the jaw.

METHODS AND RESULTS

The study included 74 cases of osteosarcoma of the jaw. Their clinical, radiographic and histopathological features were analysed, and their frequency with respect to aggressive and malignant pathologies of the jaw was determined. Survival was assessed in 17 cases with available follow-up. Osteosarcoma of the jaw accounted for 10% of primary malignant and aggressive tumours of the jaw, and for 8% of all malignant lesions of the jaw, including metastatic and lymphoproliferative tumours. The mean age was 43 ± 18 years. Radiographic features varied greatly and were non-specific, with a predominance of mixed images. The dominant histological pattern was osteoblastic (48.4%), followed by chondroblastic (37.1%). The survival rate at 5 years was 68%. Females and patients with a predominantly chondroblastic pattern had lower survival rates.

CONCLUSIONS

Osteosarcoma of the jaw was the most frequent primary malignant tumour of the jaw. Female gender and a predominantly chondroblastic pattern may be associated with a worse prognosis.

Osteosarcoma: A Comparison of Jaw versus Nonjaw Localizations and Review of the Literature

Purpose. It is assumed that osteosarcomas of the jaws mainly occur at older ages, whereas the most prominent sites, that is, the long bones, are more affected at ages <20. Jaw-localized tumors are less malignant and have lower metastatic spread rates. Patients and Methods. This study analyses the nationwide data of the Dutch Cancer Registry on osteosarcoma during the period from 1991 to 2010. Age-corrected incidence rates were calculated. Results. In 949, 38 patients had tumors in the maxilla and in 58 in the mandible. Median age for maxilla, mandible, and other localizations was 45.5, 49, and 23 years, respectively. Age-corrected incidence for osteosarcomas increased after a steep decline for the age cohorts from 20 to 60 years to nearly the same level as the younger patients. The incidence for maxillary lesions showed a steady increase from 0.46 to 1.60 per million over all age ranges; the highest incidence for mandibular lesions was found in the age cohort from 60 to 79 years. In respect to histology, no shifts for age were found, except for Paget's disease-related osteosarcoma. In older patients, chemotherapy was omitted more often. Overall survival was similar for all age groups, except for extragnatic tumor patients in the age range of 60-79 years. Conclusions. Osteosarcomas have comparable incidences below the age of 20 as compared with ages >60 years. Poorer outcome in older people is likely due to refraining from chemotherapy.

Prognostic factors for teenage and adult patients with high-grade osteosarcoma: an analysis of 240 patients

The aim of this retrospective, multicenter study was to evaluate clinicopathological characteristics, prognostic factors and treatment outcomes of teenage and adult patients with high-grade osteosarcoma. A total of 240 osteosarcoma patients who were diagnosed and treated from March 1995 to September 2011 were analyzed. Median age was 20 years (range 13-74 years), and 153 patients (63.8%) were male. Primary tumor localization was extremity in 204 patients (85.4 %), trunk in 21 patients (8.8%) and head and neck region in 14 patients (5.9%). According to American Joint Committee on Cancer staging system, 186 patients (77.5%) were stage II, 3 (1.3%) were stage III and 48 (20.0%) were stage IV. Median overall survival (OS) was 55 months (95 % CI 36.8-73.1 months). OS after 2, 5 and 10 years were 67, 49 and 42%, respectively. Univariable analysis for OS showed that male gender (p = 0.032), high baseline lactate dehydrogenase (LDH) level (p < 0.001), high baseline serum alkaline phosphatase level (p = 0.002), telangiectatic subtype (p = 0.023), presence of metastasis at diagnosis (p < 0.001), presence of tumor positive margins after primary surgery (p = 0.015), poor pathological response to preoperative chemotherapy (p = 0.006) and presence of recurrent disease during follow-up period (p < 0.001) were significantly associated with poor survival. Patients who received postoperative methotrexate plus doxorubicin plus cisplatin (M + A + P) combination regimen (p = 0.019), underwent surgery for recurrent disease (p < 0.001) and received chemotherapy for recurrent disease (p < 0.001) had longer OS. In multivariable analysis for OS, only high LDH level (p = 0.002) and the presence of metastasis at diagnosis (p = 0.011) were associated with poor OS, whereas the patients who received chemotherapy for recurrent disease had a longer OS (p = 0.009).