Advanced osteosarcoma of the maxilla: A case report

Oral and Maxillofacial Surgery, Baleia Hospital, School of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, MG, Brazil.
Medicina oral, patologia oral y cirugia bucal (Impact Factor: 1.17). 09/2008; 13(8):E492-5.
Source: PubMed


Osteosarcomas are primary malignant bone tumours in which mesenchymal cells produce osteoid. It is generally the most common malignant bone neoplasm, although lesions of the jaw are uncommon. Osteosarcoma of the jaw (JOS) presents a lower incidence of metastasis and a better prognosis than osteosarcoma of the long bones. However, patients with JOS can exhibit advanced tumours, mainly when early diagnosis is not performed. This article reports on a case of an advanced osteosarcoma of the maxilla. A 38-year-old woman was referred for evaluation and treatment of recurrent fibrous dysplasia of the facial bones. The patient related that she had been diagnosed with fibrous dysplasia four years earlier and, since the first diagnosis, she was submitted to four surgical interventions, all followed by recurrences. The main clinical findings were redness and swelling of the facial skin, upper lip ulceration, and hard palate swelling. Computed tomography showed a large hyperdense mass in right maxilla extending to right orbit and left maxillary sinus. An incisional biopsy was performed and microscopic examination showed areas of osteoid and chondroid formation surrounded by a cellular stroma. The diagnosis of osteosarcoma was established and the patient was recommended for oncologic treatment. Unfortunately, she died six months after the diagnosis due to uncontrollable local spread.

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    • "Adequate surgical excision of the primary lesion with postoperative radiotherapy or chemotherapy in appropriate situations remains the mainstay of treatment for osteosarcoma of the jaw bone.7 Factors associated with good prognosis are a small tumor size, absence of nerve involvement, adequate surgical margin, histologically well differentiated lesion, and younger patients without associated retinoblastoma.7 "
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    • "It is instructive that, with the exception of a few reports [4,24], almost all the conclusions on the behavior of multicentric osteosarcomas are based on long-bone tumors, which are known to differ significantly in their biological behavior from that of tumors of the jaws, and cannot, therefore, be representative of multicentric osteosarcomas of the jaws [28-30]. Indeed, to date, there are only four reports of multicentric osteosarcomas involving the jawbones in the English literature [31-34]. "
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    ABSTRACT: Background In the head and neck region, osteosarcoma is the most common primary malignant bone tumor, representing 23% of total head and neck malignancies. Osteosarcomas of the jaws are nevertheless rare lesions, representing only 2 to 10% of all osteosarcomas. This report reviews a single-center histopathology experience with craniofacial osteosarcomas, and reports the management of unusually large synchronous mandibular and maxillary osteosarcomas in a patient. Patients and methods A search of the hospital pathology database for specimens with a histological diagnosis of osteosarcomas submitted between July 1992 and May 2011 was made. A chart review of a patient with large synchronous maxillary and mandibular osteosarcomas was performed, and is reported. Case presentation A 21-year-old African man with large maxillary and mandibular tumors under palliative care presented with increasing difficulties with eating, speech, and breathing. Surgical debulking was performed, with histology confirming synchronous osteosarcomas of the mandible and maxilla. The patient is well after one year, with no evidence of recurrence, having undergone no further treatment. Conclusion Osteosarcomas of the jaw remain enigmatic, and a number of difficulties related to their diagnosis and treatment are yet to be resolved. True synchronous multicentric osteosarcomas of the jaws are extremely rare but, like other osteosarcomas of the jaws, have a favorable outcome, and palliative resection of such lesions, though challenging, can therefore lead to an enormously improved quality of life and self-image, and may even offer the opportunity for cure.
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    • "Chondroblastic subtype is associated with a better prognosis than other histopathological variants.[51015] Patients with nonmetastatic OS have 70% five-year survival rate, while patients with metastasis or recurrence have a poorer prognosis with only 20% surviving at 5 years.[31215] The average survival after recurrence is less than 1 year.[12] "
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