Aggressive Osteoblastoma in the Maxilla: Unusual Lesion in the Craniofacial Skeleton

Osteoblastoma of the maxilla: A case report and review of the literature

Osteoblastoma is a benign tumour with aggressive trait usually seen in young males between 10 and 40 years of age. This condition is quite rare in children. Here, we report one such rare osteoblastoma occurring in the maxilla of a 4-year-old boy and discuss the clinical presentation, radiologic and histologic features, and treatment of this patient, and a brief review.

An unusual presentation of osteoblastoma of the maxilla: A case report

This report presents a rare case of maxillary osteoblastoma in a 17-year-old female. The patient presented with dull pain and facial asymmetry inferior to the left zygoma. An intraoral examination found a painless swelling on the buccal gingival tissue in the left posterior maxilla. Panoramic radiographs and multidetector computed tomographic images revealed an ill-defined, non-corticated, mixed attenuating entity of osseous density located within the left posterior maxilla apical to the left maxillary molars. The entity exhibited a heterogeneous internal structure with a fine granular appearance, and the periphery showed a partial hypo-attenuating rim along the antero-medial aspect. Expansion of the left posterior maxilla accompanied with displacement of the left maxillary sinus floor was noted. External root resorption of the first and second molars was noted, as well as postero-superior displacement of the third molar. The histopathologic diagnosis of the biopsy was osteoblastoma. Complete excision of the tumor was performed.

A rare case of maxillary osteoblastoma in a 10-month-old infant

Osteoblastoma (OSB) is an uncommon (3% of benign and 1% of all) primary bone neoplasm with extremely rare occurrence in head and neck, especially the maxillary bone region. OSB of the jaw mainly involves the mandible bone. We report a 10-month-old male who was admitted to the hospital because of a mass in the right maxillary jaw region. Clinicoradiopathologic features of the patient have been described. The histological examinations revealed OSB of the maxillary bone. Total surgical resection of the tumor was performed with 10 months of follow-up and there is no evidence of recurrence. To the best of our knowledge, it is the first report of maxillary OSB in an infant.

Aggressive Cranial Osteoblastoma of the Parietotemporo-Occipital Bone: A Case Report and Review of Literature with Special Emphasis on Recurrence/Residue

Osteoblastoma is a rare nonfibroblastic osteoid tissue-forming primary bony tumor usually arising in the medullary cavity/diploic space of any bone. The calvarium is an extremely rare site of its origin. Clinically, 2 types of osteoblastoma are noted: benign/conventional/typical and aggressive/high grade. Their imaging features are nondifferentiating and nonspecific, histopathologic features have a few subtle but nonspecific differences, and they have highly distinct clinical behavior. We report an extremely rare case of a patient with large aggressive cranial osteoblastoma, who developed massive inoperable multifocal recurrence 15 months after total en bloc resection with wide margins. A concise review of cases of aggressive osteoblastomas involving the cranium available in the English literature is also presented as an update.

Clinicopathologic study of 6 cases of epithelioid osteoblastoma of the jaws with immunoexpression analysis of FOS and FOSB

OBJECTIVE

The aim of this study was to describe the clinicopathologic features of a series of gnathic epithelioid osteoblastomas. As high levels of Proto-oncogene c-Fos proteins resulting from FOS-FOSB translocation were recently demonstrated in osteoblastomas, we also evaluated the immunoexpression of these proteins.

STUDY DESIGN

Records of all cases of epithelioid osteoblastoma of the jaws were retrieved from oral pathology services, and their clinicopathologic and immunohistochemical data were collected. Immunohistochemistry was also performed by using anti-FOS and anti-FOSB antibodies.

RESULTS

Six cases of epithelioid osteoblastomas were obtained, 4 in men and 2 in women, and they were mainly located in the posterior body of the mandible (n = 4). Radiographically, the tumors showed mixed radiolucent and radiopaque images, most with poorly defined margins. Microscopically, large epithelioid cells with eccentrically located nuclei predominated among osteoid and immature bone trabeculae. Sharp delineation from adjacent normal bone was observed in all cases. FOS immunostaining was diffuse and strong in the cytoplasm and nucleus of neoplastic cells in all cases, whereas FOSB was only focally positive, with few epithelioid osteoblasts showing nuclear staining.

CONCLUSIONS

Although epithelioid osteoblastomas of the jaws are locally aggressive, widespread metastasis does not occur, and, as with conventional osteoblastomas, there is wide expression of the FOS protein.

Central Osteoma of Maxilla Associated with an Impacted Tooth: Report of a Rare Case with Literature Review

Osteomas are benign osteogenic neoplasms caused by proliferation of mature compact or cancellous bone. Clinically they may be classified as peripheral, central or extraskeletal. Osteomas usually involve the craniofacial region with mandible being the most common site. Central osteoma of the jaws is a very rare entity with only 13 cases reported in the literature till date of which only five cases occurred in the maxilla. Here we present a case of a large central osteoma of anterior maxilla associated with an impacted tooth, the first of its kind and a review of literature.

Pediatric Benign Paranasal Sinus Osteoneogenic Tumors: A Case Series and Systematic Review of Outcomes, Techniques, and a Multiportal Approach

BACKGROUND

Pediatric benign paranasal sinus osteoneogenic tumors have previously been difficult to treat due to the surgical constraints of the developing skull. Progression may lead to intracranial complications or orbital and optic nerve compression.

OBJECTIVE

To assess the presentation and management of benign paranasal sinus osteoneogenic tumors.

METHODS

Systematic review of the symptoms and surgical treatment of these lesions, and a case series of 2 adolescents with osteomas impinging on the orbit treated with a multiportal approach.

RESULTS

Forty-eight cases of osteomas, osteoblastoma, or osteoid osteomas were reviewed from 43 articles. The average age was 14 years, 67% of tumors were osteomas, and 48% were greater than 3 cm in longest dimension. Compared to osteoblastomas, osteomas had a greater male to female ratio (4.3:1; P = .02), presented at older age ( P = .03) with a smaller tumor burden ( P = .003), and had prior trauma or surgery ( P < .001). The ethmoid, frontal, maxillary, and sphenoid sinuses were affected in decreasing order of frequency. A purely endoscopic sinus surgery approach was taken in 31% of cases, open approach in 62% of cases, and combined approach in 7% of cases. Osteoblastoma patients had a 32% rate of recurrence, compared to only 3% among osteoma patients. On univariate logistics regression of patient demographics, tumor characteristics, and surgical approaches predictive of surgical outcomes, only tumor type was predictive of postoperative recurrence (odds ratio: 0.07; 95% confidence interval, 0.007-0.77; P = .029).

CONCLUSION

There was no association between surgical approach and postoperative complications or rate of recurrence. However, a transnasal and transorbital multiportal approach avoids facial incisions.