Advertisement

Head and Neck Pathology

, Volume 5, Issue 1, pp 92–99 | Cite as

The Spectrum of Gnathic Osteosarcoma: Caveats for the Clinician and the Pathologist

  • Ricardo J. Padilla
  • Valerie A. Murrah
Case Report

Abstract

Seven expansile jaw lesions in patients ranging from 7 to 63 years are presented to illustrate diagnostic and management issues pertaining to cases ultimately proven to be gnathic osteosarcoma (GO). Six of the cases in our series were low-grade osteoblastic and one high-grade chondroblastic. None of our cases exhibited the characteristic “sunburst” radiopaque appearance described for GO. All of our cases displayed cortical expansion and one showed development of diastema. Two occurred in the maxilla and five in the mandible. Two of the patients with mandibular lesions presented initially with pain; all other patients were asymptomatic. Lack of pain resulted in a delay in diagnosis due to postponement of consultation or biopsy. Two cases underwent initial shallow non-representative biopsies, requiring a second biopsy for definitive diagnosis, further delaying treatment. Those biopsies were initially interpreted as pyogenic granuloma and peripheral ossifying fibroma, respectively. GO should always be considered in the differential diagnosis of expansile jaw lesions. Bone biopsies of lesions exhibiting pain and expansion of cortical plates should include medullary bone in order to minimize sampling error. In addition, all rapidly growing or painful exophytic bone lesions, and presumed soft tissue lesions that may involve underlying bone, should be examined histopathologically, and receive clinical and radiographic follow-up until complete resolution or healing is evident, regardless of the diagnosis. Based on the positive outcomes of the patients in our series, the prognosis of GO appears to be relatively favorable when compared to other sarcomas and osteosarcomas of long bones.

Keywords

Osteosarcoma Gnathic Bone tumor Jaws Maxillofacial Bone biopsy Oral and maxillofacial pathology Head and neck pathology 

References

  1. 1.
    Fletcher CDM, Unni KK, Mertens F, editors. World Health Organization classification of tumors. Pathology and genetics of tumors of soft tissue and bone. Lyon: IARC Press; 2002.Google Scholar
  2. 2.
    Barnes L, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumours. Pathology and genetics of head and neck tumours. Lyon: IARC Press; 2005.Google Scholar
  3. 3.
    Fernandez R, Nikitakis NG, Pazoli A, Ord RA. Osteogenic sarcoma of the jaw: a 10-year experience. J Oral Maxillofac Surg. 2007;65(7):1286–91.CrossRefGoogle Scholar
  4. 4.
    Cheng YS, Wright JM, Walstad WR, Finn MD. Osteosarcoma arising in Paget’s disease of the mandible. Oral Oncol. 2002;38(8):785–92.CrossRefPubMedGoogle Scholar
  5. 5.
    Bramer JA, Abdulu AA, Tillman RM, Carter SR, Sumathi VP, Grimer RJ. Pre- and post-chemotherapy alkaline phosphatase levels as prognostic indicators in adults with localised osteosarcoma. Eur J Cancer. 2005;41(18):2846–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Nissanka EH, Amaratunge EA, Tilakaratne WM. Clinicopathological analysis of osteosarcoma of jaw bones. Oral Dis. 2007;13(1):82–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Guadagnolo BA, Zagars GK, Raymond AK, Benjamin RS, Sturgis EM. Osteosarcoma of the jaw/craniofacial region: outcomes after multimodality treatment. Cancer. 2009;115(14):3262–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Niswander LM, Kim SY. Stratifying osteosarcoma: minimizing and maximizing therapy. Curr Oncol Rep. 2010;12(4):266–70.CrossRefPubMedGoogle Scholar
  9. 9.
    Eftekhari F. Imaging assessment of osteosarcoma in childhood and adolescence: diagnosis, staging, and evaluating response to chemotherapy. Cancer Treat Res. 2010;152:33–62.CrossRefGoogle Scholar
  10. 10.
    Bennett JH, Thomas G, Evans AW, Speight PM. Osteosarcoma of the jaws: a 30-year retrospective review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(3):323–32.CrossRefPubMedGoogle Scholar
  11. 11.
    Givol N, Buchner A, Taicher S, Kaffle I. Radiological features of osteogenic sarcoma of the jaws. A comparative study of different radiographic modalities. Dentomaxillofac Radiol. 1998;27(6):313–20.CrossRefPubMedGoogle Scholar
  12. 12.
    Vencio EF, Reeve CM, Unni KK, Nascimento AG. Mesenchymal chondrosarcoma of the jaw bones: clinicopathologic study of 19 cases. Cancer. 1998;82(12):2350–5.CrossRefPubMedGoogle Scholar

Copyright information

© Humana 2010

Authors and Affiliations

  1. 1.Division of Oral and Maxillofacial Pathology, Department of Diagnostic SciencesUniversity of North CarolinaChapel HillUSA

Personalised recommendations