Osteosarcoma of the jaw bones

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.

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.

The Role of Immunohistochemistry for Primary Oral Diagnosis in a Brazilian Oral Pathology Service

A proper antibody panel selection is one of the most important factors to reach an adequate diagnosis in challenging cases. This retrospective study was designed to determine the contribution of immunohistochemistry (IHC) in the primary diagnosis of oral diseases in one of the main services of oral pathology in the State of São Paulo, Brazil, and to identify the most common antibodies used, and recommend diagnostic algorithms based on our experience with challenging lesions. A total of 1698 IHC stains were performed in 401 cases from a total of 28,804 cases received from public dental clinics and private dental practitioners within a period of 13 years, representing a frequency of 1.4% of IHC solicitations. Among these, 112 (28%) were mandatory to reach a final diagnosis and 255 (63.6%) were confirmative. In 34 (8.4%) cases, it was not possible to reach a conclusive/final diagnosis, even with IHC. Regarding the nature of the lesions, 210 (52.3%) were benign, 163 (40.6%) were malignant tumors, 13 (3.2%) were reactive, 10 (2.5%) were premalignant, and 5 (1.2%) were lesions of uncertain malignancy. Small amount of tissue of some incisional biopsies, overlapping features of spindle cell lesions (epithelial, neural, melanocytic, smooth muscle, endothelial, and fibroblastic/myofibroblastic cell differentiation), and overlapping features of salivary gland lesions were the most frequent challenges in which IHC stains were requested. Spindle cell lesions were the most frequent (22%) among all cases that required IHC to reach a final diagnosis. The implementation of IHC for routine practice requires a wide range of markers, proper antibody selection, and knowledge to interpret the subjectivity of staining. The inherent limitation of incisional biopsies was pointed as a reason to inconclusive diagnosis, despite a wide range of antibodies that our laboratory displays.

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.

Head and neck osteosarcomas: An analysis of treatment trends and survival outcomes in the United States (2004-2016)

BACKGROUND

Head and neck osteosarcoma (HNOS) is a rare primary bone tumor with limited data to guide treatment approaches.

METHODS

The NCDB was used to identify patients diagnosed with HNOS. Kaplan-Meier and Cox multivariate regression were used to examine the impact of each treatment on overall survival (OS).

RESULTS

We identified 821 patients diagnosed with HNOS. Utilization of neoadjuvant chemotherapy + surgery increased from zero cases in 2004 to 24% of cases in 2016. Among surgically treated patients, 5-year OS was 55.8% (CI: 51.7-60.1%). No difference was seen in OS between each treatment cohort on multivariate analysis. However, neoadjuvant chemotherapy + surgery + adjuvant chemotherapy had improved 18-month survival compared to surgery alone (95.8% vs. 78.5%, p = 0.031).

CONCLUSIONS

Our study demonstrated no survival benefit in perioperative chemotherapy or radiation therapy; however, short-term survival improvement in patients receiving both neoadjuvant and adjuvant chemotherapy displays promise and requires further investigation.

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).

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.

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 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.

Osteosarcoma of the mandible masquerading as a dental abscess: report of a case

An aggressive and fatal case of osteosarcoma of the mandible in a 19-year-old female is reported. Six weeks after the clinical appearance of the swelling, the patient died. This paper is unique in that the age of occurrence and the biologic behavior of the tumor were not consistent with the reported literature. The case report is followed by a brief review of osteosarcoma of the jaw with a note on its clinical presentation, diverse radiologic appearance, varied histopathologic picture, and prognosis.

Peripheral osteoma of the maxillary sinus: a case report

BACKGROUND

Paranasal sinus osteomas are rare benign tumors. Although various theories such as trauma and infection have been proposed, it is difficult to establish the pathogenesis of osteoma. Osteomas may be detected with routine radiographic examination or the tumors may enlarge and cause symptoms. Osteomas most frequently occur in the frontal and ethmoid sinuses, and are rare in the maxillary sinus.

CASE REPORT

In the present study, we report a case of an 18-year-old woman with a maxillary sinus osteoma. Radiographically, the tumor was characterized as a radiopaque, well-delimited lesion in the periapical region of teeth 27 and 28 that had positive sensitivity test. After computed tomographic scanning and complete removal of the tumor, the histopathological diagnosis was osteoma. After 1 year of follow-up, the patient shows no signs of recurrence.

[Jaw osteosarcomas]

INTRODUCTION

Osteosarcoma (OS) is the most frequent bone malignant tumor. It is usually found on long bones, 5 to 10% are located on jaws, accounting for 0.5 to 1% of all facial tumors. There is little published data which concerns only few patients. Our aim was to study retrospectively cases of facial bone OS in adults, and to compare our results with published data to suggest an optimal management scheme.

PATIENTS AND METHOD

Thirty-three patients were managed for an OS, from January 1997 to January 2007. Fourteen patients with a maxillary and mandibular OS, treated in first-intention in our unit, were included. The following data were analyzed: age; personal history; circumstance of discovery; clinical, functional, and physical signs; loco-regional extension and metastasis radiological investigation. The histological slides were systematically reviewed. The protocol, therapeutic outcome, and follow-up were studied.

RESULTS

The mean age at diagnosis was 43. Swelling was the most frequent functional sign. The mean delay before management was 3.4 months. The most frequent radiological presentation was a lytic and hyperdense image. The diagnosis was suggested after CT scan in 57.1% of cases. The biopsy was correlated to the anatomopathological analysis in 78.6% of cases. The most common treatment was surgical exeresis completed by chemotherapy. The 5-year survival rate was 50%.

DISCUSSION

Jaw OS are specific because of their localization and specific bone ultrastructure. Their management remains controversial: should they be managed like limb OS or treated more specifically? Neoadjuvant chemotherapy, even if it delays exeresis for 3 months, seems to stop the growth or reduce the tumor. An early anatomopathological analysis of the surgical piece determines adjuvant therapy. The negative prognostic factors are: maxillary localization because of limited exeresis margins, tumoral size, and osteoblastic sub-type.

Osteosarcomas of the mandible: are they different from other tumor sites?

BACKGROUND

Osteosarcomas of the mandible (MOS) affect 1/10 million persons/year, mostly the young adult. Due to lack of specific data, the treatment of MOS is extrapolated from that of extragnathic OS but varies widely between institutions.

MATERIALS AND METHODS

We aimed at providing a focused description of MOS histologies and grades through the English literature, at determining the evidence-based role of chemotherapy, of adjuvant radiation therapy and the potential of reconstructive surgery tailored through modern pre-operative multi-modal imaging.

RESULTS

The estimated proportion of high grade MOS was 58%. However, low-grade MOS may be underestimated as they are mostly reported as case reports. The intermediate grade was hardly found in the literature. Estimated weighted-mean proportions of chondroblastic and osteoblastic MOS were 37% and 46%, respectively. Multimodal imaging modalities including MRI has a great potential for accurate pre-operative assessment of tumor extensions into bone and soft tissues. Surgery is the mainstay of treatment and margins the most important factor. The role of neoadjuvant chemotherapy in treating occult systemic metastases and in increasing the probability of clear margins is controversial, as well as the histology-dependent response to chemotherapy. The role of adjuvant radiotherapy (mostly proposed for positive margins) and/or adjuvant chemotherapy is still controversial. Crude survival is around 77% and local control around 67%. Local failure is the main cause of death in MOS compared to extragnathic sites.

Outcomes of patients with maxillofacial osteosarcoma: a review of 15 cases

PURPOSE

To assess clinical behavior, response to treatment, and factors affecting survival in maxillofacial osteosarcoma treated at a tertiary referral center.

PATIENTS AND METHODS

Ethics-approved retrospective review of clinical and pathological records was undertaken for 15 patients managed by the Royal Melbourne Hospital Head and Neck Oncology Tumor Stream.

RESULTS

Treatment was a combination of surgery and chemotherapy. Chemotherapy was given as adjuvant, neoadjuvant, or in combination. The overall 2-, 5-, and 15-year disease-free survival rates in this study were 92%, 74%, and 74%, respectively. Using Kaplan-Meier analysis with log rank tests, increasing T stage (P = .01) and positive margins (P = .003) were found to affect survival significantly. Neoadjuvant chemotherapy was not significantly associated with tumor necrosis or improved survival.

CONCLUSIONS

Tumor size and adequacy of local control were found to be the most important predictors of outcome.

Juxtacortical osteosarcoma of mandible

This article presents a case of juxtacortical (paraosteal) osteosarcoma in a 43-year-old female, which is rare malignant mesenchymal tumor. As per the literature, it accounts for less than 4% of all osteosarcomas. Due to its rare variety, this tumor can cause diagnostic dilemma and clinicians should be aware of it. Due to its clinical picture, it can be confused with peripheral fibro-osseous lesions. Success rate of treatment are good if the tumor is detected early and resected with wide margins giving a negligible chance for recurrence.

Imprint cytology of osteosarcoma of the jaw: a case report

Introduction

Osteosarcomas are highly malignant bone-forming neoplasms that account for about 20% of all sarcomas. In light of their aggressive behavior, early diagnosis is crucial for determining adequate treatment. Dental professionals may be the first to detect jaw osteosarcomas in their initial stages. The aim of this case report is to draw attention to the possibility of diagnosing this tumor based on clinical, radiographical and cytological characteristics before confirmation by histology.

Case presentation

A 24-year-old Afro-Brazilian man presented with swelling and pain on the left side of the mandible in the region of the third molar (tooth 38). Radiography showed a poorly delimited intraosseous lesion with radiolucent and radiopaque areas. The cytological aspects were consistent with the diagnosis of osteosarcoma, which was confirmed by biopsy.

Conclusion

Imprint cytology was found to be a reliable, rapid and easy complementary examination. An early diagnosis of osteosarcoma of the jaw is fundamental to the early determination of an adequate treatment.

Chondroblastic osteosarcoma of maxilla: a case report and review of literature

Craniofacial osteosarcoma is a relatively rare entity comprising about 6.5-7% of all osteosarcomas, whereas it is reported to be one of the most common malignancies of long bones. We present a case of chondroblastic variant of osteosarcoma (COS) of the maxilla in an 18 year-old-girl. She was treated with a subtotal maxillectomy and later referred for adjuvant chemotherapy. The relevant review of literature with regard to clinical, radiographic findings, histopathological similarities to Chondrosarcoma (CS), role of Immunohistochemistry (IHC) and management modalities of Osteosarcoma of jaw bones (OSJ) in comparison with Osteosarcoma of the long bones (OSL) are being presented in this report.

Cytological diagnosis of multiple myeloma presenting as a jaw swelling

Multiple myeloma is a systemic B-cell lymphoproliferative disease with varied manifestations. Its diagnosis can therefore pose difficulties for both the clinicians and pathologists. Jaw lesions, though not uncommon, rarely present as the first sign in multiple myeloma. We present here the case of a 45 year-old female who presented with a swelling of the jaw and on subsequent work-up, was diagnosed with multiple myeloma. Recent research regarding this disease has also been highlighted.

Expression of ezrin and metastatic tumor antigen in osteosarcomas of the jaw

AIMS AND BACKGROUND

Ezrin is a membrane-cytoskeleton linker protein involved in regulation of the growth and metastatic behavior of cancer cells. Metastatic tumor antigen (MTA) is a potential metastasis-associated protein. The objective of this study was to evaluate the expression of ezrin and MTA and their correlation with clinicopathological features in osteosarcomas of the jaw.

METHODS

We analyzed ezrin and MTA protein levels by immunohistochemistry in 31 osteosarcomas of the jaw.

RESULTS

The mean age at diagnosis was 39 years and half of the patients were male. The mandible (n = 19) was more frequently involved than the maxilla (n = 12). The predominant histological type was chondroblastic (58.1%) and 24 patients (77.4%) were classified as having a high grade of malignancy. Immunoreactivity for ezrin was identified in 6 of 31 cases (19.4%), while 77.4% displayed expression of MTA. All ezrin-positive patients had high-grade tumors. The high-grade tumors (n = 24) had a higher rate of MTA expression (42.9% vs 87.5%). Expression of ezrin and MTA was not significantly different according to age, sex, tumor site, histological type, and tumor ploidy. Follow-up information was available for 13 patients, with a mean follow-up time of 26.7 months (range, 6-48 months). At the time of last follow-up, 5 (38.5%) patients had died of disease and 8 patients (61.5%) were alive with no evidence of disease. Expression of ezrin and MTA was not significantly different according to the follow-up data.

CONCLUSIONS

In our study, high-grade tumors had a higher rate of ezrin and MTA expression. This expression pattern indicates that ezrin and MTA positivity can be additional prognostic markers in osteosarcoma of the jaw.

Clinicopathological analysis of osteosarcoma of jaw bones

OBJECTIVES

To identify clinicopathological characteristics and prognosis of osteosarcoma of the jaw bones (JOS) and to compare the data with results of similar studies. To study the effectiveness of different treatment modalities currently available for this malignancy.

SUBJECTS AND METHODS

Nineteen cases of JOS diagnosed from 1993 to 2003 were retrieved from the departmental archives. These were categorized into histopathological subtypes and graded according to the severity of the malignancies and the data analyzed. Fourteen cases were followed up and the success rate with different treatment modalities assessed.

RESULTS

The mean age for JOS was 34.1 years. There were 11 mandibular lesions and eight maxillary lesions. Osteoblastic variant (53%) was the commonest histopathological subtype. High grade (grades III and IV) was more prevalent. All 14 followed up patients underwent surgical excision--five with adjuvant radiotherapy and six with adjuvant chemotherapy. Local recurrence was the commonest complication. Nine of the 14 were surviving with a survival rate of 64.2% for a median follow-up period of 5.25 years.

CONCLUSIONS

JOS is a distinct group of lesions with a better prognosis if diagnosed and treated early. It does not show any ethnic variability. Existing histopathological typing and grading may not indicate the prognosis of JOS. Adjuvant chemotherapy is a better treatment modality than adjuvant radiotherapy.

[Chondroblastic osteosarcoma of the mandible: a case report with 14 years follow-up]

INTRODUCTION

Osteosarcoma, the second most frequent primary malignant bone tumor, is usually found in long bones: femur, tibia or humerus with only 6 to 7% of cases occurring in the jaws. Patients with osteosarcoma of the mandible usually complain of a swelling, which can be painful or not, accompanied by paresthesia of one of the trigeminal nerve branches in about 20% of cases.

OBSERVATION

We report a case of chondroblastic osteosarcoma of the mandible affecting a 33-year-old woman with 14 years follow-up illustrating the difficulties of a rapid diagnosis.

DISCUSSION

The prognosis of osteosarcoma of the mandible relies on its histological grade and the amount of time elapsing from diagnosis to treatment onset. The treatment of choice is radical surgery providing a 5-year survival rate up to 80%. The definitive surgical treatment is usually performed only after several interventions because operative-room pathology cannot be obtained due to the necessity of decalcification. In order to avoid multiple resections, an interim bridging with a reconstructive plate with a condylar head can be proposed before definitive graft reconstruction. The prognosis of osteosarcoma of the mandible is better than that of long bones. Chemotherapy or radiotherapy, which are very efficient for osteosarcoma in general, do not change the prognosis of osteosarcoma of the mandible.

Free osseous and soft tissue surgical margins as prognostic factors in mandibular osteosarcoma

Osteosarcoma is an infrequent, locally aggressive neoplasm in the head and neck region. To date, surgery is the mainstay of treatment. However, patients with mandibular osteosarcomas usually have a locally advanced disease at diagnosis and therefore represent a therapeutic challenge because surgical margins are difficult to obtain due to aesthetic and functional concerns. To evaluate possible prognostic factors implicated in recurrence, persistence or relapse in osteosarcoma of the mandible, with special reference to the soft tissue and bone surgical margins. A series of 20 patients with mandibular osteosarcomas treated at the Instituto Nacional de Cancerología (México) from 1985 to 1999 are reviewed. There were 14 female and 6 male patients. Twelve cases were treated with surgery alone, 3 patients with surgery and adjuvant radiotherapy, 1 had neoadjuvant chemotherapy followed by surgery, 1 had neoadjuvant chemotherapy, surgery and postoperative radiotherapy, 1 with surgery and adjuvant chemotherapy, 1 with surgery followed by adjuvant chemotherapy and radiotherapy and one patient rejected treatment. Between 1985 and 1992 these neoplasms were treated by means of total mandibulectomy, independently of tumor size, but between 1993 and 1999 the policy was to practice smaller resections but long enough to obtain macroscopic surgical free margins. In the first period the relationship between mandibular size resection and tumor size was 1.9, meanwhile in the second period the relation was 1.5. There was not significant difference between both periods in terms of tumor size (6.0 cm vs. 6.02 cm at the time of surgery) nor in local control and survival. Soft tissue involvement as reported by histological study was strongly associated with recurrence (p = 0.0024). Overall 5-year survival was 20%. A policy of total mandibulectomy is not associated with a better local control or survival. Extent of resection must be tailored with tumor size. Extent of margins in soft tissue is the limiting factor for local control.

Osteogenic sarcoma of the jaw bones: A single institution experience over a 21-year period

OBJECTIVE

The purpose of this article is to review cases of osteogenic sarcoma of the jaw bones diagnosed in our institution during a 21-year period.

STUDY DESIGN

Records of patients seen at the Lagos University Teaching Hospital between January 1983 and December 2003 with histologic diagnosis of osteogenic sarcoma were analyzed for age and gender of patients, as well as sites and histologic types of tumor.

RESULTS

Osteogenic sarcoma of the jaws constituted 0.6% of all the biopsies of oral and jaw lesions seen within the period under study. The mean (+/-SD) age of patients at presentation was 27.2 +/- 13.6 years (range 11-70 years). The mean age of patients with maxillary lesions, 30.7 +/- 15.8 years (range 17-70 years), was higher than that of patients with mandibular lesions, 23.4 +/- 10.1 years (range 11-40 years); however, no statistical significance difference was found (P = .08) There were 12 male and 5 female patients, a ratio of 2.4:1. Nine (53%) tumors were found in the maxilla and 8 (47%) in the mandible, a ratio of 1.1:1. The mandibular lesions were predominant in female patients, while the maxillary lesions were predominant in male patients. The most common histologic subtype was chondroblastic (47%), followed by fibroblastic (35.3%) and osteoblastic types (17.7%).

CONCLUSION

Osteogenic sarcoma of the jaws is rare in patients who presented with tumor and tumor-like lesions of the jaws in our center, in agreement with previous reports from Africa and other centers around the world. However, the mean age at presentation of our patients was lower than reported in other parts of the world.

The clinical and diagnostic imaging findings of osteosarcoma of the jaw

OBJECTIVE

To clarify the valuable clinical features and diagnostic imaging findings regarding the diagnosis of osteosarcoma of the jaw (OSJ).

MATERIALS AND METHODS

The initial symptoms and diagnostic imaging findings of 10 patients with OSJ were analysed. The points analysed on the diagnostic images were as follows: any widening of the periodontal ligament space of the teeth on the periphery of the OSJ; the presence of radial spicules and Codman's triangle; any signs of bone destruction; and the patterns of osteogenesis.

RESULTS

All patients had pain and/or swelling of the affected site, and all OSJs, except for one edentulous case, showed a widening of the periodontal ligament space of the teeth on the periphery of the OSJ. Radial spicules or Codman's triangle were observed in only three cases (30%). Four out of five mandibular OSJs were osteolytic or osteolytic dominant with bone destruction, while, in contrast, four out of five maxillary OSJs were osteogenic or osteogenic dominant, and three out of the four maxillary OSJs did not show bone destruction. The osteogenic OSJ without bone destruction was similar to some benign cemento-osseous lesions of the jaw and thus was difficult to diagnose as OSJ based on the diagnostic imaging findings alone.

CONCLUSION

Even though some OSJ showed features similar to the benign tumours of the jaw bone based on the diagnostic imaging findings, the pain and swelling of the affected site, and the widening of the periodontal ligament space of the teeth on the periphery of OSJ were considered to be common findings, which may help in making an accurate diagnosis of OSJ in this limited series.

Osteosarcoma of the jaws in children

Two cases of osteosarcoma of the jaws in children are reported. One patient was a 13-year-old girl whose first symptoms included nasal and maxillary sinus congestion, followed by epistaxis. She was found to have chondroblastic osteosarcoma extending through the left maxillary alveolar process and sinus. Following surgery and chemotherapy, the patient has been free of disease for 7 years. The second patient, an 8-year-old boy, was diagnosed with juxtacortical (parosteal) osteosarcoma of the mandible, which is a less aggressive variant of the neoplasm. It is believed that this is the youngest patient reported to date with juxtacortical osteosarcoma of the jaws. He was treated by block resection of the right side of the mandible and is free of disease 3(1/2) years later.

Osteosarcoma presenting as an aggressive nodular mass in the region of the mandible

Osteosarcomas are highly malignant neoplasms of bone that are challenging to diagnose. These neoplasms often show atypical behavior. In the initial phase they may present as nondescript bony swellings with an indolent growth rate, only to become overtly aggressive and malignant towards the later phase of the disease. Similarly, the histological growth pattern of this neoplasm can be quite diverse, presenting with areas that mimic benign myofibroblastic tumors, giant cell granulomatous conditions and partial encapsulation. The final diagnosis of an osteosarcoma is often reached after thorough sampling and examination of multiple biopsy specimens. All these clinical features and histological diagnostic difficulties were encountered in a case of osteosarcoma affecting the right mandible of a 62-year-old Chinese woman described here. The diagnostic lessons accrued from this case are discussed.

Clinicopathological and immunohistochemical analysis of twenty-five head and neck osteosarcomas

The aim of this study was to analyze the clinicopathological features and immunohistochemical expression of p53, MDM2, CDK4, PCNA and Ki67 proteins in 25 head and neck osteosarcomas registered in a single institution. The mean age of the patients was 29 years and the most common site was the mandible (60%). The predominant histological type was the chondroblastic (72%) and 52% of the cases were classified as intermediate-grade of malignancy. The immunohistochemical analysis displayed positivity in 52% of the cases for p53, 24% for MDM2, 84% for CDK4, 92% for PCNA and 88% for Ki-67. The majority of cases were treated with surgery alone or associated with chemotherapy. Five patients developed local recurrences, four had distant metastasis and six had persistent disease after initial treatment. The overall 5-year and 10-year survival rates were 59% and 49%, respectively, and the most important prognostic factors were prior history of radiation exposure and osteoblastic histological type.

Osteosarcoma arising in Paget's disease of the mandible

Although osteosarcoma is a well-known complication of Paget's disease of bone, it uncommonly develops in the jaw bones. We present an osteosarcoma arising in Paget's disease of the mandible with unique features of a normal serum alkaline phosphatase level, and histologic features of telangiectatic change in the osteosarcoma and association with cemento-osseous dysplasia. Sixteen reported cases of osteosarcoma arising in Paget's disease of the jaw bones (OPJ) are also reviewed and compared to osteosarcoma arising in Paget's disease occurring in the entire skeleton (OPS) and osteosarcoma arising de novo in the jaw bones (OJ). Females are more commonly involved in OPJ in contrast to a male predominance in OPS and OJ. OPJ also has a distinctively higher percentage involving blacks compared to OPS. The prognosis of OPJ is poor, with 69% of patients dying within two years after diagnosis. Early recognition, early and aggressive treatment are important to improve the prognosis and are hence emphasized.

Osteosarcoma of the temporomandibular joint: report of 2 cases

The aim of this article is to report 2 cases of osteosarcoma of the mandibular condyle, a rare pathological condition, and to emphasize and discuss the usefulness of different imaging modalities in the diagnosis and evaluation of osteosarcoma of the temporomandibular joint. In our assessment of the different imaging modalities, we found that 2-dimensional computed tomograms provide excellent detection of tumor calcification, cortical involvement, and in most instances, soft tissue and intramedullary extension, whereas 3-dimensional computed tomography vascular protocol can help to define the extension of the lesion, improving the visualization of the lesion's relationship to the adjacent anatomical structures. Magnetic resonance imaging is more effective in demonstrating the intramedullary and extraosseous tumor components on T2 weighted images. Because metastasis from body tumors to the maxillofacial region occurs occasionally, it is useful to examine the oral cavity when symptoms first appear and devote special attention to the subtle changes that may indicate early metastatic involvement.

[Osteosarcoma and chondrosarcoma--radiographic differentiation with computerized tomography]

The purpose of this paper was to associate and compare the radiographic patterns of osteosarcoma and those of chondrosarcoma by means of computed tomography (CT). Computed tomographs of five cases of osteosarcoma and five cases of chondrosarcoma of the head and neck region were analyzed. The sensitivity of CT was calculated based on the results of histopathological examinations. We concluded that CT can facilitate the establishment of the final diagnosis since it is possible to distinguish the individual characteristics of osteosarcomas and chondrosarcomas in that exam.

Osteosarcoma of the jaw bones

Currently, it has been established that osteosarcoma (OS) of bone is not a stereotyped disease, and several varieties have been identified by clinical findings, radiographic and histopathologic appearances. Generally, it is the most common primary malignant bone neoplasm that accounts for at least 30% of all primary tumours of bone. In the jaw bones, OS accounts for about 4% of all the primary malignant neoplasms. In the general skeleton, the highest incidence is observed in the second decade of life; the neoplasm is said to be unusual before the age of 5 years and very rare after age 50 years. The aetiology and precise pathogenesis of this disease remain unknown. A diagnosis of clinically and radiologically suspicious OS requires meticulous histologic examination. However, histologic diagnosis may also be difficult since the different varieties of OS may have different morphological patterns in different sample sites. Currently, the two therapeutic modalities used in the primary treatment of OS include radical surgery and cytotoxic chemotherapy. In the general skeleton, the use of surgery alone results in a 90% rate of recurrence of OS. Notably, the advent of adjuvant and neoadjuvant cytotoxic chemotherapy as an adjunct to radical surgery has greatly improved the prognosis of many cases of OS of the jaw bones.

Osteosarcoma of the jaw. The Chaim Sheba Medical Center experience

OBJECTIVE

The purpose of this article is to present 14 cases of osteosarcoma of the jaw treated at our medical center from 1989 to 1998. These cases are discussed in the light of a comprehensive review of 774 cases reported in the English literature over the past 3 decades. Differences between osteosarcoma of the jaws and osteosarcoma of the long bones are examined.

SUBJECTS AND METHODS

The patients ranged in age from 8 to 78 years, the mean age being 33 years. Each patient had a histopathologically established diagnosis of osteosarcoma of the jaw. Records were reviewed for epidemiologic data, treatment modalities, and survival.

RESULTS

Of the 14 patients, 6 (42%) had tumors in the mandible and 8 (58%) had tumors in the maxilla. Of the mandibular tumors, 5 occurred in the body of the mandible; all maxillary tumors originated in the alveolar ridge and involved the maxillary sinus. The chief complaint was an intraoral or extraoral painless swelling. Histopathologic types included chondroblastic, osteoblastic, fibroblastic, and malignant fibrous histiocytoma-like. Pathologic grade was determined to be high (3 or 4) in 13 cases and low (1) in only 1 mandibular case. All patients underwent surgical resection and immediate reconstruction. Adjuvant therapy included postoperative radiation (5 patients), postoperative chemotherapy (2 patients), and preoperative chemotherapy and postoperative radiation (1 patient).

CONCLUSIONS

The results of the present study support the literature indicating that osteosarcoma of the jaw differs from osteosarcoma of the long bones in its biological behavior even though they have the same histologic appearance. Because of differences in tumor characteristics, the introduction of chemotherapy did not dramatically alter the prognosis of osteosarcoma of the jaw. Early diagnosis and radical surgery are the keys to high survival rates.

A rare tumor of craniofacial bones in children: a pediatric chondroblastic osteosarcoma case with diagnostic and therapeutic problems

Osteosarcoma of the cranial facial region is uncommon and only rarely involves the ethmoid or sphenoid bones. The authors report on an unusual case of a 17-year-old male presenting with chondroblastic osteosarcoma of the maxillary, ethmoid, and sphenoid sinuses who remains well and disease-free at 46 months. He was treated with anterior craniofacial resection followed by postoperative radiotherapy to the sight of the primary tumor. He did not receive chemotherapy because of emerging hepatitis-B infection and vasculitis. The literature on extragnathic craniofacial osteosarcomas is reviewed with particular emphasis on treatment options of this rare tumor.

Osteosarcomas of flat bones in adolescents and adults

BACKGROUND

Osteosarcomas typically are long bone tumors and rarely affect the flat bones of the axial or appendicular skeleton.

METHODS

The authors examined cases of high grade osteosarcoma of flat bones diagnosed at La Timone Adults University Hospital during a 16-year period.

RESULTS

Sixteen patients with flat bone osteosarcomas were treated between 1980-1997. The median age of the patients was 25 years, with a male-to-female ratio of 14:2. Common presenting symptoms were swelling, pain, or both. Primary therapy included resection (n = 11 patients: alone in 8 patients and with radiation therapy in 3 patients), radiation therapy (n = 2 patients), or no local treatment (n = 3 patients). All patients received polychemotherapy, 7 preoperatively and postoperatively and 9 in the adjuvant setting. The overall 5-year survival rate was 47.7%; the overall median survival was 39 months (range, 4-211 months). The adequate local control rate was 68.7%. The local recurrence rate in patients who benefited from local treatment was 54%. Significant adverse prognostic factors on survival included the presence of synchronous metastases (three patients), metastases at any time during the course of the disease (eight patients), and inadequate local control (five patients). The overriding predictor of survival appeared to be the presence of metastases. Local recurrence appeared to have no influence on survival. No patient with metastases was alive at 3 years, whereas patients without recurrence or with local recurrence alone had a 5-year survival rate of 100%. Because the majority of patients with flat bone osteosarcomas ultimately die of metastatic disease, intensive systematic polychemotherapy should be an important component of treating these tumors.

CONCLUSIONS

Based on the very encouraging results observed in the treatment of long bone osteosarcomas, the therapy for flat bone osteosarcomas should combine radical surgery with preoperative and postoperative adjuvant chemotherapy.

Well-differentiated intraosseous osteosarcoma of the jaws: experience of two cases from the Instituto Nacional de Cancerología, México

Osteosarcomas of the jaws represent less than 10% of all osteosarcomas, and most of them are high-grade neoplasms. Prognostic factors in overall survival include tumor size, location and histologic grade. Examples of well-differentiated (low-grade) intraosseous osteosarcomas of the jaws (WDIOJ) have been rarely reported. This article presents two cases of this unusual lesion, one of which was located in the maxilla of a 17-year-old man and the other developed in the mandible of a 37-year-old woman. CT scan was necessary to detect the small foci of penetration into the thinned cortical bone and the reactive periosteal bone formation, which are important findings to establish the correct diagnosis of WDIOJ and help to exclude other benign intraosseous lesions that may be very similar histologically, such as fibrous dysplasia, ossifying and desmoplastic fibromas. In spite of tumor size (mean 5.2 cm), their well-demarcated borders allowed complete removal of both tumors. There is no evidence of tumoral activity in any of our patients after follow-up periods of 15 months and 5 years. Wide excision seems to be the treatment of choice for this subgroup of osteosarcomas.

Osteosarcoma of the maxillofacial bones in Kenyans

Osteosarcoma (OS) is a highly malignant tumour and is the most common primary neoplasm of bone; although rare, especially in the maxillofacial skeleton. This article presents 14 Kenyan cases of OS of the maxillofacial bones seen between January 1991 and July 1997: 11 in the mandible, two in the maxilla and one in the right zygomatic arch. Patients ranged in age from one week to 50 years (Mean = 29.7), with an equal gender distribution. While pain and rapid swelling were the commonest clinical features, the radiographic and histopathological characteristics were as varied as has been described elsewhere. Generally, effective management of most of the cases was poor due to late presentation for treatment.