Myxoid Chondrosarcoma of Maxilla in a Pediatric Patient: A Rare Case Report

Chondrosarcoma of the maxilla in a young female: A case report

ABSTRACT

Sarcomas of the head and neck region are rare tumors, constituting less than 1% of malignant neoplasms in this area. Approximately 20% of these sarcomas originate from bone or cartilage. Chondrosarcomas are malignant mesenchymal tumors showing cartilaginous differentiation. These tumors usually show a predilection to the male gender and occur commonly in the older age group. Here, we report a case of chondrosarcoma of the anterior maxilla in a young female.

Chondrosarcoma of Maxilla - A Rare Case Report

Rationale

Chondrosarcoma, although being a rare entity in jaws, may turn fatal if left untreated or inadequately excised. Prognosis in terms of 5-year survival rate ranges from 90% for Grade I, 81% for Grade II and 43% for Grade III respectively.

Patient Concerns

A 35-year-old male patient reported with a gradually progressive hard painless growth over right maxillary molar region. His main concern was removal of pathology without long-term morbidity.

Diagnosis

Computed tomography revealed ill-defined mass with internal calcification involving posterior half of upper right alveolus.

Treatment and Outcomes

Mandatory biopsy suggested benign chondroma, however wide excision and infrastructural maxillectomy revealed Grade II chondrosarcoma.

Take-away Lessons

Complex anatomy of maxilla renders surgical excision of chondrosarcomas with histological clear margins, a daunting task. Due to misdiagnosis of preoperative biopsy, suboptimal excision of malignant mass may lead to local recurrence and occasional distant metastasis. This necessitates further therapy and long term follow up, with occasional poor patient compliance.

Management of Chondrosarcomas of the Jaws in a Nigerian Tertiary Hospital

Background

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

Objectives

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

Materials and Methods

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

Results

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

Conclusions

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

Chondrosarcoma in a paediatric population: a study of 247 cases

PURPOSE

The aims of present study are to clarify the follow questions: 1) what constitutes paediatric chondrosarcoma?; 2) what are the effects of the demographic and tumour characteristics on survival in patients with paediatric chondrosarcoma?; 3) which prognostic factors of paediatric chondrosarcoma differ from those of the adult population, which have been reported previously?

METHODS

Paediatric patients who were diagnosed with chondrosarcoma were searched for using the case listing session protocol of the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 databases (1973 to 2014). The extracted demographic information includes: age, race, gender, year of diagnosis, tumour sites, tumour histological subtype, grade, stage and treatment.

RESULTS

A total of 247 paediatric chondrosarcoma patients were extracted and included in our present study. We find that the paediatric patients have significantly better survival rates than the adult patients. The year of diagnosis, tumour sites, tumour histological subtype, grade, stage and surgery received are independent prognostic factors for the survival rate of paediatric chondrosarcoma patients, but race, gender and age are not.

CONCLUSION

The paediatric chondrosarcoma patients have better survival rates than the adults. Paediatric patients with a diagnosis at an early age, tumour site at the vertebral column and pelvis/sacrococcyx, myxoid variants, high grade, distant stage and who did not have surgery have a poorer prognosis than patients with a diagnosis at a later age, tumour site at limbs, head and base, chondrosarcoma not otherwise specified, lower grade, localized stage and who received surgery.

LEVEL OF EVIDENCE

II -Prognostic Study.

Extraskeletal Myxoid Chondrosarcoma: A Comparative Study of Imaging and Pathology

The purpose of this study was to achieve better understanding of extraskeletal myxoid chondrosarcoma (EMC). 13 cases of EMC confirmed by surgery biopsy were retrospectively studied. All patients underwent preoperative CT or/and MRI examinations. Among six patients who underwent preoperative CT examinations, six cases of lesions exhibited hypodensity on unenhanced image, three cases of tumor showed funicular spots or patchy calcification, and four cases of tumor did not show any obvious enhancement after enhanced CT scan. Among ten patients who underwent preoperative MRI examination, 8 cases of tumor revealed uniform or slight hyposignal intensity on T1WI, 10 cases of tumor demonstrated lobulated hypersignal intensity with multiple low signal intensity of interval septa on T2WI, and 5 cases of lesions indicated characteristic appearance: septa enhancement with tumor stroma between interval septa being unenhanced. EMC usually occurred at older men and at certain location such as limbs, trunk, and subcutaneous tissues. EMC usually exhibited low density mass (mostly 20-40HU) with calcification and in a portion of the cases showed light or no enhancement on CT. On MRI, EMC showed lobulated hypersignal intensity on T2WI with characteristic arc, septa, or interval septa enhancement.

Extraskeletal Myxoid Chondrosarcoma of Nasopharynx: An Oncologic Entity Rarely Reported

Extraskeletal myxoid chondrosarcoma (ESMC) is an extremely rare variant of chondrosarcoma accounting for less than 10% cases. It affects mainly the soft tissues of the proximal end of long bones. Its incidence in the head and neck region is less than 5%. This case presented in the nasopharynx, an exceedingly unusual site for ESMC in a 60-year-old female with left-sided nasal obstruction and occasional epistaxis of one-year duration. Biopsy from the nasopharyngeal mass was suggestive of low-grade chondrosarcoma. She underwent endoscopic resection of the tumor. Postoperative histopathology confirmed the diagnosis as myxoid chondrosarcoma of nasopharynx after performing a battery of immunohistochemical markers to rule out other possible differential diagnoses. We treated her with conformal adjuvant radiotherapy to a dose of 66 Gray in 33 fractions given residual disease to which she responded well with significant symptomatic and radiological improvement. The patient has been on regular follow-up for over two years without any evidence of recurrence or distant metastasis. This case is presented to highlight the extreme rarity, the clinicopathological findings of this disease, and to emphasize the role of radiotherapy as the primary adjuvant treatment affecting the final prognosis. A thorough review of the literature reveals that our case may be the second case of myxoid chondrosarcoma of nasopharynx ever reported in the world literature to date.