Epithelioid osteosarcoma of the mandible: a rare case with unusual immunoprofile

Maxillary Parosteal Osteosarcoma: Additional case Report and Literature Review of Surface Osteosarcomas

Introduction: Surface osteosarcomas represent around 3-6% of all osteosarcomas, which include the parosteal (low-grade), periosteal (intermediate-grade) and high-grade surface osteosarcomas. The classical location is the femur, followed by tibia and humerus. Parosteal osteosarcoma is the most common type of surface osteosarcoma. To date, 26 cases of parosteal osteosarcoma affecting the jaws have been reported, with most cases following an evolution time of several months to years, clinically favoring a benign osseous or fibro-osseous lesion. Methods: Here, we report a 39-year-old female who was referred presenting a maxillary tumoral mass 5 years ago, clinically diagnosed as osteoma. After clinical, imaginological and histopathological analysis, a diagnosis of parosteal osteosarcoma was made. Conclusion: Thus, parosteal osteosarcoma should also be considered in the differential diagnosis of benign-appearance, bone-forming nodular lesions affecting the jaws.

Rosette-forming epithelioid osteosarcoma in the rib: a rare case of location and morphology

The rib is an unusual location for osteosarcoma and is reported in only 2% of all cases. The major histological variants of osteosarcoma are osteoblastic, chondroblastic, and fibroblastic, with a few rare variants including one epithelioid type. This report describes a 44-year-old male with an osteolytic mass in the right seventh rib. Histological examination revealed osteosarcoma with unique features of epithelioid appearance and rosette structures. To the best of our knowledge, this is the first reported case of a rosette-forming osteosarcoma of the rib that showed epithelioid morphology. Despite successful surgery, the patient’s prognosis was poor because this malignancy had an unusual location within the axial skeleton and was a rare histological variant.

Functions of Matricellular Proteins in Dental Tissues and Their Emerging Roles in Orofacial Tissue Development, Maintenance, and Disease

Matricellular proteins (MCPs) are defined as extracellular matrix (ECM) associated proteins that are important regulators and integrators of microenvironmental signals, contributing to the dynamic nature of ECM signalling. There is a growing understanding of the role of matricellular proteins in cellular processes governing tissue development as well as in disease pathogenesis. In this review, the expression and functions of different MP family members (periostin, CCNs, TSPs, SIBLINGs and others) are presented, specifically in relation to craniofacial development and the maintenance of orofacial tissues, including bone, gingiva, oral mucosa, palate and the dental pulp. As will be discussed, each MP family member has been shown to have non-redundant roles in development, tissue homeostasis, wound healing, pathology and tumorigenesis of orofacial and dental tissues.

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).

Metachronous extraskeletal (soft tissue) epithelioid osteogenic sarcoma: a case report

Background

Metachronous osteosarcoma is a rare form of osteosarcoma. The occurrence of metachronous tumor in soft tissue is exceedingly rare. The pathogenesis of metachronous osteosarcoma, as to whether it represents multiple true primaries or metastatic disease, is still obscure.

Case presentation

A 49-year-old Indian man presented with progressively increasing swelling in his left hand of 2 months’ duration. An X-ray showed a soft tissue lesion. Contrast-enhanced computed tomography showed a soft tissue mass lesion, with peripheral enhancement and central necrotic areas in radial palmar soft tissue overlying second metacarpophalangeal region with no obvious bony osteolysis. Possibilities of acute abscess, resolving hematoma, or aggressive soft tissue mass lesion were suggested. An incision biopsy showed morphological features of epithelioid osteosarcoma, which was confirmed on immunohistochemistry. A detailed history revealed that our patient was diagnosed as having osteosarcoma of his right leg 3 years previously. Based on history, radiology, morphology, and immunohistochemistry, a final diagnosis of extraskeletal (soft tissue) epithelioid osteogenic sarcoma of the left hand occurring as a metachronous tumor 3 years after diagnosis of primary osteosarcoma in the right leg was given.

Conclusion

This is probably the first reported case of extraskeletal (soft tissue) epithelioid osteosarcoma occurring as a metachronous tumor 3 years after diagnosis of primary osteosarcoma in the right leg. The prognosis of metachronous skeletal osteosarcoma is poor as compared to that of relapse limited to lungs. In late metachronous osteosarcoma, combined-modality therapy comprising surgery and aggressive chemotherapy may affect long-term survival. Lifelong follow-up of surviving patients with osteosarcoma is necessary and if metachronous osteosarcoma is discovered, it should be treated with curative intent.

Electronic supplementary material

The online version of this article (10.1186/s13256-019-2070-3) contains supplementary material, which is available to authorized users.

Chondroblastic osteosarcoma mimicking periapical abscess

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

Epithelioid Osteosarcoma of the Maxilla

Epithelioid osteosarcoma is an uncommon variant; only 4 cases have been reported in the jaw area, 2 of which were in the maxilla. A 22-year-old woman, in the eighth month of pregnancy, presented to the oral surgery clinic with a mass in the right maxilla that had rapidly expanded over the past 3 months. Computed tomography scans showed an ill-defined sclerotic destructive lesion that formed bone matrix in its soft tissue extension. Microscopic examination of the lesion revealed malignant epithelioid cells with osteoid deposits. The tumor cells were shown to have pale cytoplasm, vesicular nuclei, and prominent nucleoli and to undergo frequent mitosis. In addition, the tumor was positive for epithelial membrane antigen and vimentin and negative for AE1/AE3, Melan-A, CD30, synaptophysin, NSE, CD45, CD99, desmin, and myogenin. The final diagnosis was epithelioid osteosarcoma, which is a rare aggressive variant of osteosarcoma. Few cases of epithelioid osteosarcoma have been reported in the literature, and more studies are required to determine the clinical behavior of this tumor.

Diversity of Histologic Patterns and Expression of Cytoskeletal Proteins in Canine Skeletal Osteosarcoma

Osteosarcoma (OS), the most common bone tumor, includes OS of the head (OSH) and appendicular OS (OSA). In dogs, it is classified into 6 histologic subtypes: osteoblastic, chondroblastic, fibroblastic, telangiectatic, giant cell, and poorly differentiated. This study investigated the significance of the histologic classification relevant to clinical outcome and the histologic and immunohistochemical relationships between pleomorphism and expression of cytoskeletal proteins in 60 cases each of OSH and OSA. Most neoplasms exhibited histologic diversity, and 64% of OS contained multiple subtypes. In addition to the above 6 subtypes, myxoid, round cell, and epithelioid subtypes were observed. Although the epithelioid subtypes were observed in only OSH, no significant difference in the frequency of other subtypes was observed. Also, no significant relevance was observed between the clinical outcome and histologic subtypes. Cytokeratin (CK) was expressed in both epithelioid and sarcomatoid tumor cells in various subtypes, and all CK-positive tumor cells also expressed vimentin. Vimentin and α-smooth muscle actin (SMA) were expressed in all subtypes. A few SMA-positive spindle-shaped tumor cells exhibited desmin expression. Glial fibrillary acidic protein-positive tumor cells were observed in many subtypes, and some of these cells showed neurofilament expression. Although OSH exhibited significantly stronger immunoreactivity for SMA than OSA, no significant difference in other cytoskeletal proteins was observed. Some tumor cells had cytoskeletal protein expression compatible with the corresponding histologic subtypes, such as CK in the epithelioid subtype and SMA in the fibroblastic subtype. Thus, canine skeletal OS is composed of pleomorphic and heterogenous tumor cells as is reflected in the diversity of histologic patterns and expression of cytoskeletal proteins.

Osteopontin upregulates the expression of glucose transporters in osteosarcoma cells

Osteosarcoma is the most common primary malignancy of bone. Even after the traditional standard surgical therapy, metastasis still occurs in a high percentage of patients. Glucose is an important source of metabolic energy for tumor proliferation and survival. Tumors usually overexpress glucose transporters, especially hypoxia-responsive glucose transporter 1 and glucose transporter 3. Osteopontin, hypoxia-responsive glucose transporter 1, and glucose transporter 3 are overexpressed in many types of tumors and have been linked to tumorigenesis and metastasis. In this study, we investigated the regulation of glucose transporters by osteopontin in osteosarcoma. We observed that both glucose transporters and osteopontin were upregulated in hypoxic human osteosarcoma cells. Endogenously released osteopontin regulated the expression of glucose transporter 1 and glucose transporter 3 in osteosarcoma and enhanced glucose uptake into cells via the αvβ3 integrin. Knockdown of osteopontin induced cell death in 20% of osteosarcoma cells. Phloretin, a glucose transporter inhibitor, also caused cell death by treatment alone. The phloretin-induced cell death was significantly enhanced in osteopontin knockdown osteosarcoma cells. Combination of a low dose of phloretin and chemotherapeutic drugs, such as daunomycin, 5-Fu, etoposide, and methotrexate, exhibited synergistic cytotoxic effects in three osteosarcoma cell lines. Inhibition of glucose transporters markedly potentiated the apoptotic sensitivity of chemotherapeutic drugs in osteosarcoma. These results indicate that the combination of a low dose of a glucose transporter inhibitor with cytotoxic drugs may be beneficial for treating osteosarcoma patients.

A large multifocal aggressive osteoblastoma of mandible: an immunohistochemistry case study report

Aggressive osteoblastoma (AO) is a benign osteoblastic tumor which is rare in the head and neck region. Clinical and histo-logical features are therefore overlap with other benign and low-grade malignant tumors. The aim of this article is to report and discuss the differential diagnosis of an aggressive osteoblastoma in the mandible. A 25-year-old male patient reported with pain and asymmetry on the left side of the face since 8 months previously. Radiographic evaluation showed a mixed lesion extending from approximately the lower left premolar to the third molar region. After incisional biopsy, resection with continuity defect was carried out. Microscopic findings showed woven bone and bony trabeculae with varied degrees of mineralization along with sheets of osteoblast cells. Immunohistochemistry showed that p53 and cytokeratin (CK) were negative and ki-67 index was 7%. Postoperative follow-up for 15 months showed no evidence of recurrence.

Primitive Myxoid Mesenchymal Tumor of Infancy With Rosettes

Primitive myxoid mesenchymal tumor of infancy (PMMTI) is a relatively recently described tumor arising in infants and demonstrating a unique histomorphology. We present an unusual case of PMMTI with rosettes, a hitherto undescribed finding in the reported cases. We also present the cytogenetic and ultrastructural findings of this tumor and review the literature. As awareness of PMMTI increases, additional clinical data and histopathologic findings will aid in the morphologic and behavioral characterization of this neoplasm.

Osteosarcoma of mandible: Detailed radiographic assessment of a case

Osteosarcoma (OS) is a malignant connective tissue tumor originating from bone and is the most common primary bone malignancy of long bones but seldom arises in jaw bones. Osteosarcoma of jaws is frequently seen arising in the second and third decade as compared to earlier occurrences in other bones and show a slight predilection for body of mandible. It is a highly malignant tumor with varied radiographic features. We present a case with detailed radiographic assessment using intraoral radiograph, computed tomography (CT), 3-D CT, CT angiography techniques and histological evaluation.

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.

Epithelioid osteosarcoma of the jaw

Epithelioid osteosarcoma (OS) is a rare sub-type of OS with an aggressive behavior. An epithelioid OS was diagnosed in an 8-year-old female with painful swelling of the left jaw. After two courses of chemotherapy (cisplatin/methotrexate/doxorubicin), the patient presented a progressive disease. After hemimandibulectomy, 13 courses of post-operative chemotherapy (cisplatin/methotrexate/doxorubicin/ifosfamide) were performed. Histological and ultra-structural examination showed a high grade neoplasm consisting of sheets of epithelioid cells with focal osteoid formation. The patient is alive and in complete remission 42 months from diagnosis.