Osteosarcoma of the jaws: a review of literature and a case report on synchronous multicentric osteosarcomas

3D print model for surgical planning in a case of recurrent osteoblastic osteosarcoma of the left maxilla. A case report

Osteosarcoma (OS) of the head and neck is a rare and aggressive disease characterized by the formation of osteoid by malignant osteoblasts. The mandible or maxilla are the most common sites of presentation. Radiologically, these tumors show considerable, destructive growth with periosteal reaction, which can suggest the diagnosis of OS. 3D printing, as an emerging technology, can play a role in orthopedic oncology by providing patient-specific 3D printed models to improve surgical planning and facilitate patient understanding. We present the case of a male in his early 30s with a final histological diagnosis of recurrent osteosarcoma of the left maxilla, where a 3D printed model was helpful for the diagnostic workup, surgical planning, and the procedure.

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 jaws: A case report

Introduction

Osteosarcomas of the jaws are very rare accounting for only 6 to 7% of all osteosarcomas and 1% of all head and neck malignancies.

The clinicopathological characteristics as well as the radiological characteristics are not specific, which represents a diagnostic dilemma. Indeed, this lesion is often mistaken for benign lesions of the maxillary.

Case presentation

We report a case of osteosarcoma of the jaws in a 45 year man who consulted in our service for a simple painless oral swelling evolving since a five months.

The lesion was excised and histopathological report confirmed the diagnosis of osteosarcoma of the jaw.

Discussion

Osteosarcomas are a rarely progressive tumor in the oral cavity that can show up as a case of a benign process of dental origin. During our practice, we often meet similar cases which are treated by usual medication, while a whole malignant process is in the progress and can be life-threatening. The case we present illustrates this perfectly, and owing to a deep clinical investment, the malignant process was stopped at its start.

Conclusion

The objective of presenting this case is to draw the attention of the doctors that any lesions even of benign appearance can hide a malignant process. Consider this point and integrate it into its diagnostic approach should be undertaken and should lead to a deepening of the clinical examination by comparing the clinical, radiological and histological data.

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Never underestimate a lesion of usual appearence; a whole malignant process can be hidden.

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A dippening of clinical and paraclinical investigations is an approch to adopt.

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Early diagnosis can improve the management of the desease and save lives.

Diagnostic Challenges in Chondroblastic Maxillary Osteosarcoma: A Case Report

The diagnosis of craniofacial osteosarcoma can be quite challenging, and the condition often goes unrecognized for a considerable period of time. In this report, we discuss the case of a 21-year old woman who presented with a one-year history of a small swelling over the left maxillary alveolar ridge. Upon further investigation, the histopathological examination showed high-grade chondroblastic osteosarcoma. The option of four cycles of neoadjuvant chemotherapy regimen preoperatively was chosen, and left inferior maxillectomy was performed along with reconstruction with obturator prosthesis. This case highlights the difficulties encountered in such rare cases of craniofacial osteosarcomas both in terms of the delay in the establishment of the diagnosis as well as management protocol. A high index of suspicion is required in cases of craniofacial osteosarcoma and early surgical resection with adequate safety margins is warranted.

Tangeretin-Assisted Platinum Nanoparticles Enhance the Apoptotic Properties of Doxorubicin: Combination Therapy for Osteosarcoma Treatment

Osteosarcoma (OS) is the most common type of cancer and the most frequent malignant bone tumor in childhood and adolescence. Nanomedicine has become an indispensable field in biomedical and clinical research, with nanoparticles (NPs) promising to increase the therapeutic efficacy of anticancer drugs. Doxorubicin (DOX) is a commonly used chemotherapeutic drug against OS; however, it causes severe side effects that restrict its clinical applications. Here, we investigated whether combining platinum NPs (PtNPs) and DOX could increase their anticancer activity in human bone OS epithelial cells (U2OS). PtNPs with nontoxic, effective, thermally stable, and thermoplasmonic properties were synthesized and characterized using tangeretin. We examined the combined effects of PtNPs and DOX on cell viability, proliferation, and morphology, reactive oxygen species (ROS) generation, lipid peroxidation, nitric oxide, protein carbonyl content, antioxidants, mitochondrial membrane potential (MMP), adenosine tri phosphate (ATP) level, apoptotic and antiapoptotic gene expression, oxidative stress-induced DNA damage, and DNA repair genes. PtNPs and DOX significantly inhibited U2OS viability and proliferation in a dose-dependent manner, increasing lactate dehydrogenase leakage, ROS generation, and malondialdehyde, nitric oxide, and carbonylated protein levels. Mitochondrial dysfunction was confirmed by reduced MMP, decreased ATP levels, and upregulated apoptotic/downregulated antiapoptotic gene expression. Oxidative stress was a major cause of cytotoxicity and genotoxicity, confirmed by decreased levels of various antioxidants. Furthermore, PtNPs and DOX increased 8-oxo-dG and 8-oxo-G levels and induced DNA damage and repair gene expression. Combination of cisplatin and DOX potentially induce apoptosis comparable to PtNPs and DOX. To the best of our knowledge, this is the first report to describe the combined effects of PtNPs and DOX in OS.

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.

Iatrogenic seeding of osteosarcoma in a tracheotomy tract - a case report

Here, we describe the first reported case of osteosarcoma occurring postsurgically in a tracheotomy tract, highlighting the possibility of osteosarcoma seeding during head and neck surgery. Preventative measures such as performing the tracheostomy after the tumor resection while walling off the tracheostomy site from the operative field should be considered.

Clinicopathologic Study of Intra- Osseous Lesions of the Jaws in Southern Iranian Population

STATEMENT OF THE PROBLEM

It is necessary for surgeons and practitioners to know about relative incidence and clinicopathologic features of lesions for accurate diagnosis and approach of pathologic lesions. Data are limited about overall incidence of intra-osseous lesions of the jaws in Iranian patients.

PURPOSE

This study evaluated the clinicopathologic features of intra- osseous lesions of the jaws in an Iranian population, in a 22-year period.

MATERIALS AND METHOD

In this cross- sectional retrospective analytical study, 4500 specimens in a 22- year period were reviewed. Baseline data of all patients with intra- osseous lesions including type and location of lesions as well as patients' age and gender, were collected and analyzed by SPSS software using descriptive analysis and Chi-square test.

RESULTS

There were 1121 (25%) intra-osseous lesion. Odontogenic cysts and benign non- odontogenic bone lesions were the most common categories, respectively. The mean age of the patients was 30.1±16, the total male to female ratio was 1.1:1, and the most prevalent location of lesions was posterior of mandible.

CONCLUSION

The results showed baseline information of intra-osseous lesions that were essentially similar to other populations; however, there were a few geographical differences. Further comprehensive studies in other parts of country are required to make a more reliable source of reference for clinicians and surgeons for evaluating and managing their patients more properly.

Necrosis of osteosarcoma cells induces the production and release of high-mobility group box 1 protein

Osteosarcoma is among the commonly observed malignancies worldwide. High-mobility group box 1 protein (HMGB1) is a highly conserved protein and is involved in the progression of various types of human cancer. The aim of the present study was to explore whether the level of HMGB1 was involved in the necrosis of osteosarcoma cells. Doxorubicin (DXR), as an inducer of necrosis, was administered to human osteosarcoma cell lines (MG63, Saos-2 and U2OS), and the results indicated that 0.5 µg/ml DXR significantly induced the necrosis of MG63 cells (P<0.01), while 0.5 and 1.0 µg/ml DXR suppressed the viability of MG63 and U2OS cells (P<0.05), relative to untreated controls. Additionally, treatment with DXR was observed by western blot analysis to markedly increase the expression levels of HMGB1 in MG63 cells, and to significantly increase the levels of secreted HMGB1 in the supernatants of MG63 and U2OS cells (P<0.01). In conclusion, cell necrosis increased the level of HMGB1 in osteosarcoma cells, as well as the level of secreted HMGB1 in cell supernatants. Therefore, HMGB1 may be a potential target in molecular therapy for patients with osteosarcoma.

Chondroblastic osteosarcoma mimicking periapical abscess

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

Osteosarcoma of Jaw with Varying Histomorphologic Patterns: Case Report

Introduction:

Osteosarcoma is a malignant mesenchymal tumor whose cancerous cells produce osteoid matrix. It is a common primary malignant bone tumor, representing 23% of total head and neck malignancies. Osteosarcomas of the jaws are rare lesions, representing only 4-7% of all osteosarcomas. This presentation discusses the clinical, radiographical, and histopathological features of a case of osteosarcoma of the mandible with unusual histopathological appearance.

Case Report:

A 21-year-old male patient reported with a diffuse swelling of the right side of mandible with dull ache and increasing difficulties with eating and speech. Incisional biopsy done showed a histopathological picture of osteosarcoma and osteoblastoma. Hemimandibulectomy was done and the histopathology showed varying patterns of the lesion-like osteoblastoma-like osteosarcoma and osteoblastic variant of osteosarcoma. Focal areas in the lesion also showed fibrohistiocytic differentiation which may be mistaken for malignant fibrous histiocytoma. Hemangiopericytomatous appearance was also seen. Hence, it was necessary to differentiate between all the lesions as the treatment plan for all these lesions is different. Rarely, tumor may show a spectrum of histopathology as seen here in a case of osteosarcoma of the mandible.

Conclusion:

The treatment plan and prognosis for each type of these lesions are different. Thus, thorough histopathological evaluation will help in accurate diagnosis, proper treatment planning, and prognosis of these lesions.

Chondroblastic osteosarcoma arising in the maxilla mimicking the radiographic and histological characteristics of cemento-osseous lesions: A case report

Osteosarcomas of the jaw are comparatively rare and represent only 2-10% of all osteosarcomas. We herein present a rare case of an osteosarcoma exhibiting the radiographic and histological characteristics of cemento-osseous lesions in the alveolar ridge of the maxilla. A 53-year-old male patient presented with the complaint of gradual swelling of the left maxilla over 4 years. Radiography revealed an ill-defined radioopaque mass, intimately associated with the apices of the involved teeth, without a periosteal reaction. Microscopically, a cementicle-like structure was identified in the alveolar bone. In addition, the lesion exhibited typical characteristics of chondroblastic osteosarcoma in the body of the maxilla. The tumor contained abundant osteoid and cartilage intimately associated with anaplastic tumor cells. The cartilage displayed malignant-appearing cells in lacunae, and there was crowding at the periphery of the lobule where the spindle cells formed sheets. The differential diagnosis included primary osteosarcoma, concurrent cemento-osseous dysplasia and osteosarcoma, or a secondary osteosarcoma based on a pre-existing cemento-osseous lesion. The presence of the cementicle-like structure in the alveolar bone and the involvement of the periodontal ligament and alveolar bone proper were unique in our case. The general invasive growth pattern and the abundance of the irregular tumor bone helped establish the diagnosis of primary osteosarcoma. This case may represent evidence of the pathogenesis of primary osteosarcoma in the jaw.

Osteosarcoma of the posterior maxilla

Osteosarcoma is a very uncommon tumor of the maxillofacial region. Due to the occurrence of the tumor at a young age and its aggressive nature, radical surgery forms the only modality of treatment. A combination of radiotherapy and postoperative chemotherapy has been used for the management of this tumor. A case report of osteosarcoma of the posterior maxilla in an adolescent with a 1-year disease-free follow-up is presented in this report.

Misdiagnosis of osteosarcoma as cementoblastoma from an atypical mandibular swelling: A case report

Cementoblastoma is a form of benign odontogenic tumor, with the preferred treatment consisting of tooth extraction and follow-up examinations, while in certain cases, follow-up examinations without surgery are performed. Osteosarcoma of the jaw is a rare, malignant, mesenchymal tumor, associated with a high mortality rate and low incidence of metastasis. Cementoblastoma and osteosarcoma of the jaw are dissimilar in terms of their histological type and prognosis; however, there are a number of covert associations between them. The present study describes the case of a 20-year-old female with an unusual swelling in the left mandible that had been present for 2 years. The patient was initially clinically diagnosed with cementoblastoma; however, following pathological examination, a diagnosis of osteosarcoma was confirmed. A total mandibulectomy was performed on the left mandible, with a fibular osteomyocutaneous flap used for reconstruction. At the 6-month post-operative examination, the patient demonstrated normal occlusion and oral commissure, and no recurrence or metastasis was observed over 2 years of follow-up.

Cancer and Referred Facial Pain

Orofacial pain may be a symptom of diverse types of cancers as a result of local or distant tumor effects. The pain can be presented with the same characteristics as any other orofacial pain disorder, and this should be recognized by the clinician. Orofacial pain also can arise as a consequence of cancer therapy. In the present article, we review the mechanisms of cancer-associated facial pain, its clinical presentation, and cancer therapy associated with orofacial pain.

Two-Piece Hollow Bulb Obturator for Postsurgical Partial Maxillectomy Defect in a Young Patient Revamping Lost Malar Prominence: A Clinical Report

The most frequent type of treatment for patients diagnosed with a malignant neoplasia of the oral cavity is surgical resection of the tumor. Ablative surgery may be followed by a reconstructive phase, in which the surgeon may choose between local flaps, nonvascularized bone grafts or free vascularized flaps to close the surgical site, depending on the general conditions of the patient. Esthetic and functional results are challenging to achieve for the prosthodontist, as variable amount of hard and soft tissues are removed. This report describes the fabrication of a two-piece hollow obturator for a 19-year-old patient who underwent wide surgical excision of the osteosarcoma of the maxilla and was rehabilitated to function. In this case, the surgical site was covered with submental flap, and the second piece of the obturator provided fullness to the lost malar prominence.

Chromosome 12 long arm rearrangement covering MDM2 and RASAL1 is associated with aggressive craniofacial juvenile ossifying fibroma and extracranial psammomatoid fibro-osseous lesions

To evaluate the diagnostic value of MDM2 status in craniofacial fibro-osseous lesions, we investigated MDM2 expression by immunohistochemistry and analyzed MDM2 amplification by qPCR in 30 cases of ossifying fibroma (including 13 cases of the juvenile variant) and 17 cases of fibrous dysplasia. Two cases of uncommon extragnathic psammomatoid fibrous dysplasia and a mixed control group of 15 cases of low-grade osteosarcoma and 15 cases of well-differentiated/dedifferentiated liposarcoma were included. MDM2 amplification was found in 33% of ossifying fibromas (peak of 69% for the juvenile variant) and in 12% of fibrous dysplasia, in none of which was MDM2 overexpressed. All control cases exhibited MDM2 amplification and overexpression. To investigate possible polysomy of chromosome 12, we studied RASAL1 amplification, a gene telomeric to MDM2 on the long arm of chromosome 12. RASAL1 amplification was reported in all benign fibro-osseous lesions exhibiting MDM2 amplification but not in controls. Simultaneous amplification of these two genes was significantly higher in juvenile ossifying fibromas compared with fibrous dysplasia (P=0.004), non-juvenile ossifying fibromas (P=0.001), and all other benign craniofacial fibro-osseous lesions combined (P=0.0001). Of the nine cases of juvenile ossifying fibroma exhibiting amplification, three were locally invasive and four were recurrent, suggesting aggressive disease. The two cases of extragnathic psammomatoid fibrous dysplasia also showed MDM2 and RASAL1 amplification with no MDM2 overexpression. This large chromosome 12 rearrangement, spanning MDM2 and RASAL1, is the first recurrent molecular abnormality to be reported in juvenile ossifying fibroma. It may represent both a molecular diagnostic marker and a characteristic of more aggressive forms with a higher risk of recurrence. Finally, the presence of this rearrangement in extragnathic psammomatoid fibro-osseous lesions mimicking ossifying fibromas might reflect a common molecular pathway in their pathogenesis and calls into question the classification of such lesions within fibrous dysplasia.

Palliative reconstructive surgery: contextualizing palliation in resource-poor settings

Introduction. Palliative care in Kenya and the larger Sub-Saharan Africa is considered a preserve of hospices, where these exist. Surgical training does not arm the surgeon with the skills needed to deal with the care of palliative patients. Resource constraints demand that the surgeon be multidiscipline trained so as to be able to adequately address the needs of a growing population of patients that could benefit from surgical palliation. Patients and Methods. The author describes his experience in the management of a series of 31 palliative care patients, aged 8 to 82 years. There were a total of nine known or presumed mortalities in the first year following surgery; 17 patients experienced an improved quality of life for at least 6 months after surgery. Fourteen of these were disease-free at 6 months. Conclusion. Palliative reconstructive surgery is indicated in a select number of patients. Although cure is not the primary intent of palliative surgery, the potential benefits of an improved quality of life and the possibility of cure should encourage a more proactive role for the surgeon. The need for palliative care can be expected to increase significantly in Africa, with the estimated fourfold increase of cancer patients over the next 50 years.

Pathological and clinical features of primary osseous tumours of the jaw

Primary bone tumors of the jaw are rare. The neoplastic cells in these tumors are the osteoblasts and osteoclasts. The gnathic bone tumors have also been referred to as borderline. The clinicopathologic approach towards these bony lesions have been reviewed.

Osteosarcoma of the jaws: case report on synchronous multicentric osteosarcomas

Research has shown that osteosarcomas display high potential for metastasis to the lungs, pleurae and bones. Mandible, on the other hand, is an uncommon site for metastatic tumour cell colonization. Nevertheless, a metastatic tumour to mandible might be the first indication of an undiscovered malignancy at a distant site. This case report presents a case of a 61-year-old female patient. An osteosarcoma metastasized to her mandible shortly after the curettage of her jaw cyst. Both the metastatic osteosarcoma and the jaw cyst were confirmed by pathology. Initially, bilateral well-defined radiolucent lesions were shown in her panoramic X-ray image. Also, the diagnosis of a dentigerous cyst was made, based on histology. Two months later, a mixed radiolucent-radio opaque mass, which was confirmed as an osteosarcoma by pathology later, occupied the site of the previously enucleated dentigerous cyst, in her right mandible. Then, an identical osteosarcoma was found in the left pelvis on further doing overall radiological and pathological examinations. The pathologic hypotheses, treatment modality and follow-up of this case have also been presented.

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.