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Wu S, Wang Y, Zhang J, He Z, Sun Y, Ye M. Clinical significance of adjuvant therapy after radical surgery for primary osteosarcoma of the jaws. Wien Klin Wochenschr 2023; 135:488-495. [PMID: 37308792 DOI: 10.1007/s00508-023-02228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Osteosarcoma of the jaw is one of the rare malignancies and the role of postoperative adjuvant therapy is unclear. This study explored the efficacy of adjuvant therapy after radical surgery for primary osteosarcoma of the jaw. METHODS The data were retrospectively analyzed from May 2012 to June 2021. The recurrence rate, disease-free survival (DFS) and 5‑year overall survival (OS) rate were calculated by Kaplan-Meier method. Intergroup rates were examined by chi-square test. RESULTS 125 post-radical surgery patients were included. The median follow-up time was 66 months. Forty five cases suffered recurrence. The recurrence rate was 36.0%, and the 5‑year OS rate was 68.8%. In the adjuvant treatment group, twenty eight of 99 patients experienced disease progression. In the surgical treatment alone group, seventeen of 26 patients experienced disease progression. The recurrence rates in the two groups were 28.3 and 65.4%, respectively (χ2 = 12.303, p < 0.001). The 5‑year OS rate was 75.8 and 42.3%, respectively (χ2 = 10.734, p = 0.001). The median DFS of the relapse patients was 15.1 months (95% CI:13.00-17.20 months), and the 5‑year OS rate was 40.0%. Among them, 28 patients received adjuvant therapy while 17 received surgical treatment alone. The median DFS was 15.7 and 11.5 months, respectively, p = 0.024. The median OS was 69.6 months (95% CI 55.69 ~ 83.51 months) and 62.4 months (95% CI 49.06 ~ 75.74 months), respectively(p = 0.034). CONCLUSION Adjuvant therapy is one of the effective measures to reduce the relapse rate and improve OS after radical surgery for primary osteosarcoma of the jaw.
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Affiliation(s)
- Shenghong Wu
- Department of Medical Oncology, Fengxian District Central Hospital, 201499, Shanghai, China
| | - Yu Wang
- Department of Oncology, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - Jinfeng Zhang
- Department of Medical Oncology, Fengxian District Central Hospital, 201499, Shanghai, China
| | - Zhonghui He
- Department of Medical Oncology, Fengxian District Central Hospital, 201499, Shanghai, China
| | - Yuanjue Sun
- Department of Medical Oncology, Sixth People's Hospital, Shanghai Jiao Tong University, 201306, Shanghai, China
| | - Ming Ye
- Department of Radiotherapy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, No.160 Pujian Road, 200127, Shanghai, China.
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Astl J, Belsan T, Michnova L, Kubeš J, Filipovsky T, Blecha J, Holy R. Highly Aggressive Osteosarcoma of the Ethmoids and Maxillary Sinus-A Case of Successful Surgery and Proton Beam Radiotherapy in a 65-Year-Old Man. Medicina (B Aires) 2022; 58:medicina58091141. [PMID: 36143818 PMCID: PMC9500801 DOI: 10.3390/medicina58091141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/20/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022] Open
Abstract
Sarcomas in the head and neck area are rare diseases with an incidence of under 1% of all head and neck malignant tumours. Osteosarcomas or osteogenic sarcomas consist of neoplastic cells that produce osteoid bone or immature bone. Sarcomas develop more in the mandible than the maxilla. The exact diagnosis of different types of sarcomas is based on the immunohistochemical investigation. These rare tumours are of mesenchymal origin; osteosarcomas and chondrosarcomas are the most common types—Ewing’s sarcomas. The use of proton beam radiotherapy in the treatment of osteosarcoma of the maxilla is rarely reported in the literature. We present a case of successfully treated (surgery and proton beam radiotherapy) poorly differentiated highly aggressive osteosarcoma in the ethmoids and maxillary sinus and morbidity after the treatment. We were presented with a case of a 65-year-old man with anaesthesia and palsy of the right face. The stomatology department performed the extraction of a tooth. One month later, the wound was still open. The histology showed an osteogenic sarcoma in the area of the wound. The oncologist and maxillofacial surgeons in a catchment hospital recommended a nonsurgical approach. Hence, we performed a radical maxillectomy and ethmoidectomy, after which we continued with proton bean radiotherapy. The patient is now five years after therapy without signs of sarcoma; however, he has blindness in the right eye and reduced vision in the left eye, as well as gliosis of the brain, vertigo, tinnitus, trismus, and ancylostomiases. Head and neck osteosarcomas treatment is considered a complex multidisciplinary task. It is currently argued that there is no clear therapeutic protocol for successful treatment. Innovations in treatment modalities such as proton beam radiotherapy appear to have potential, although their effects on long-term morbidity and survival outcomes are still undetermined. We present a rare case report of an osteosarcoma of the maxilla involving an innovative, successful treatment procedure combining surgical excision followed by proton beam radiotherapy. This treatment approach may enable maximum tumour control. This protocol has not been adequately described in the world literature for this diagnosis.
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Affiliation(s)
- Jaromír Astl
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
- Department of Otolaryngology, Institute of Postgradual Medical Education, 10005 Prague, Czech Republic
| | - Tomas Belsan
- Department of Radiology, Military University Hospital, 16902 Prague, Czech Republic
| | - Ludmila Michnova
- Department of Pathology, Military University Hospital, 16902 Prague, Czech Republic
| | - Jiří Kubeš
- Proton Therapy Center Czech, 18000 Prague, Czech Republic
- Department of Oncology, Second Faculty of Medicine, Charles University, University Hospital in Motol, 15000 Prague, Czech Republic
| | - Tomas Filipovsky
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Jiri Blecha
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Richard Holy
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
- Correspondence:
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Owosho AA, Ladeji AM, Adesina OM, Adebiyi KE, Olajide MA, Okunade T, Palmer J, Kehinde T, Vos JA, Cole G, Summersgill KF. SATB2 and MDM2 Immunoexpression and Diagnostic Role in Primary Osteosarcomas of the Jaw. Dent J (Basel) 2021; 10:dj10010004. [PMID: 35049602 PMCID: PMC8775091 DOI: 10.3390/dj10010004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 02/06/2023] Open
Abstract
Primary osteosarcomas of the jaw (OSJ) are rare, accounting for 6% of all osteosarcomas. This study aims to determine the value of SATB2 and MDM2 immunohistochemistry (IHC) in differentiating OSJ from other jawbone mimickers, such as benign fibro-osseous lesions (BFOLs) of the jaw or Ewing sarcoma of the jaw. Certain subsets of osteosarcoma harbor a supernumerary ring and/or giant marker chromosomes with amplification of the 12q13-15 region, including the murine double-minute type 2 (MDM2) and cyclin-dependent kinase 4 (CDK4) genes. Special AT-rich sequence-binding protein 2 (SATB2) is an immunophenotypic marker for osteoblastic differentiation. Cases of OSJ, BFOLs (ossifying fibroma and fibrous dysplasia) of the jaw, and Ewing sarcoma of the jaw were retrieved from the Departments of Oral Pathology and Oral Medicine, Faculty of Dentistry, Obafemi Awolowo University and Lagos State University College of Medicine, Nigeria. All OSJ retrieved showed histologic features of high-grade osteosarcoma. IHC for SATB2 (clone EP281) and MDM2 (clone IF2), as well as fluorescence in situ hybridization (FISH) for MDM2 amplification, were performed on all cases. SATB2 was expressed in a strong intensity and diffuse staining pattern in all cases (11 OSJ, including a small-cell variant, 7 ossifying fibromas, and 5 fibrous dysplasias) except in Ewing sarcoma, where it was negative in neoplastic cells. MDM2 was expressed in a weak to moderate intensity and scattered focal to limited diffuse staining pattern in 27% (3/11) of cases of OSJ and negative in all BFOLs and the Ewing sarcoma. MDM2 amplification was negative by FISH in interpretable cases. In conclusion, the three cases of high-grade OSJs that expressed MDM2 may have undergone transformation from a low-grade osteosarcoma (LGOS). SATB2 is not a dependable diagnostic marker to differentiate OSJ from BFOLs of the jaw; however, it could serve as a valuable diagnostic marker in differentiating the small-cell variant of OSJ from Ewing sarcoma of the jaw, while MDM2 may be a useful diagnostic marker in differentiating OSJ from BFOLs of the jaw, especially in the case of an LGOS or high-grade transformed osteosarcoma.
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Affiliation(s)
- Adepitan A. Owosho
- Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, MO 63501, USA;
- Correspondence: ; Tel.: +1-660-626-2843
| | - Adeola M. Ladeji
- Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, Lagos State University, Lagos 101233, Nigeria; (A.M.L.); (K.E.A.); (M.A.O.)
| | - Olufunlola M. Adesina
- Department of Oral Medicine and Oral Pathology, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.M.A.); (T.O.)
| | - Kehinde E. Adebiyi
- Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, Lagos State University, Lagos 101233, Nigeria; (A.M.L.); (K.E.A.); (M.A.O.)
| | - Mofoluwaso A. Olajide
- Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, Lagos State University, Lagos 101233, Nigeria; (A.M.L.); (K.E.A.); (M.A.O.)
| | - Toluwaniyin Okunade
- Department of Oral Medicine and Oral Pathology, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.M.A.); (T.O.)
| | - Jacob Palmer
- Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, MO 63501, USA;
| | - Temitope Kehinde
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.K.); (J.A.V.)
| | - Jeffrey A. Vos
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.K.); (J.A.V.)
| | - Grayson Cole
- Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (G.C.); (K.F.S.)
| | - Kurt F. Summersgill
- Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (G.C.); (K.F.S.)
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Mirmohammad Sadeghi H, Karimi A, Derakhshan S, Aminishakib P, Parchami K. Conventional osteosarcoma of the mandible: Report of a rare case. Clin Case Rep 2021; 9:e04843. [PMID: 34584711 PMCID: PMC8455966 DOI: 10.1002/ccr3.4843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 08/16/2021] [Accepted: 08/22/2021] [Indexed: 12/03/2022] Open
Abstract
Osteosarcoma of the jaw can be successfully treated by a single aggressive surgical operation with good prognosis. Timely diagnosis, with a complete surgical removal of the tumor with clear margins, can fulfill favorable clinical results.
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Affiliation(s)
- Hassan Mirmohammad Sadeghi
- Oral & Maxillofacial Surgery DepartmentSchool of DentistryShahid Beheshti University of Medical SciencesTehranIran
| | - Abbas Karimi
- Oral & Maxillofacial Surgery DepartmentSchool of DentistryShahid Beheshti University of Medical SciencesTehranIran
| | - Samira Derakhshan
- Oral & Maxillofacial Surgery DepartmentSchool of DentistryShahid Beheshti University of Medical SciencesTehranIran
| | - Pouyan Aminishakib
- Oral & Maxillofacial Surgery DepartmentSchool of DentistryShahid Beheshti University of Medical SciencesTehranIran
| | - Kiarash Parchami
- School of DentistryTehran University of Medical SciencesTehranIran
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5
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Sasaki A, Miyashita H, Kawaida M, Kameyama K. Low-grade osteosarcoma is predominant in gnathic osteosarcomas: A report of seven cases of osteosarcoma of the jaw. Clin Exp Dent Res 2021; 7:1175-1182. [PMID: 34008925 PMCID: PMC8638322 DOI: 10.1002/cre2.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Primary osteosarcoma of the jaw bones is very rare, and histological features of gnathic osteosarcoma remain obscure. The purpose of this study was to describe the clinicopathological features of gnathic osteosarcoma. MATERIALS AND METHODS Seven cases of gnathic osteosarcoma from Japan diagnosed during the period between 2000 and 2016 were examined retrospectively. The histology of the surgical pathology materials was reviewed by two pathologists. Clinical information was obtained from the hospital's information system. RESULTS Of the seven cases, two patients had secondary osteosarcomas. As for the five cases of primary osteosarcoma, their ages ranged from 26 to 58 years (mean: 36.2, median: 28). Histologically, three cases were fibrotic tumors composed of spindle-shaped cells with mild to moderate nuclear atypia and the collagenous stroma accompanied by woven bones or mature lamellar-like bones. Two cases had cartilage formation. MDM2 and CDK4 expression was observed in two out of three cases on immunostaining. The histopathology of these three cases was regarded as the counterpart of low-grade osteosarcomas, namely, parosteal osteosarcoma and low-grade central osteosarcoma, arising in long bones. CONCLUSIONS The surprisingly high incidence (60%, 3/5 cases) of low-grade osteosarcoma explains the reason why gnathic osteosarcomas present a more favorable prognosis than osteosarcomas arising in long bones. Furthermore, it provides insight into the tumorigenesis mechanism of low-grade osteosarcomas arising in the jaw and other sites.
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Affiliation(s)
- Aya Sasaki
- Department of Pathology and Laboratory Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan.,Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan
| | - Hidetaka Miyashita
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Miho Kawaida
- Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan
| | - Kaori Kameyama
- Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan
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Primary and radiation induced skull base osteosarcoma: a systematic review of clinical features and treatment outcomes. J Neurooncol 2021; 153:183-202. [PMID: 33999382 DOI: 10.1007/s11060-021-03757-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/09/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE We aim to systematically review and summarize the demographics, clinical features, management strategies, and clinical outcomes of primary and radiation-induced skull-base osteosarcoma (SBO). METHODS PubMed, Scopus, and Cochrane databases were used to identify relevant articles. Papers including SBO cases and sufficient clinical outcome data were included. A comprehensive clinical characteristic review and survival analysis were also conducted. RESULTS Forty-one studies describing 67 patients were included. The median age was 31 years (male = 59.7%). The middle skull-base was most commonly involved (52.7%), followed by anterior (34.5%) and posterior (12.7%) skull-base. Headache (27%), exophthalmos (18%), and diplopia (10%) were common presenting symptoms. Sixty-eight percent of patients had primary SBO, while 25% had radiation-induced SBO. Surgery was the main treatment modality in 89% of cases. Chemotherapy was administered in 65.7% and radiotherapy in 50%. Median progression-free survival (PFS) was 12 months, and the overall 5-year survival was 22%. The five-year survival rates of radiation-induced SBO and primary SBO were 39% and 16%, respectively (P < 0.05). CONCLUSION SBO is a malignant disease with poor survival outcomes. Surgical resection is the primary management modality, in conjunction with chemotherapy and radiotherapy. Radiation-induced SBO has a superior survival outcome as compared to its primary counterpart. Complete surgical resection showed a statistically insignificant survival benefit as compared to partial resection.
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7
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Eder-Czembirek C, Moser D, Holawe S, Brodowicz T, Ries J, Sulzbacher I, Selzer E. Osteosarcoma of the jaw - experience at the Medical University Vienna and comparative study with international tumor registries. Clinics (Sao Paulo) 2019; 74:e701. [PMID: 31038644 PMCID: PMC6467170 DOI: 10.6061/clinics/2019/e701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 12/21/2018] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Christina Eder-Czembirek
- Department of Cranio, Maxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria
| | - Doris Moser
- Department of Cranio, Maxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria
| | - Simone Holawe
- Department of Cranio, Maxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria
| | - Thomas Brodowicz
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Jutta Ries
- Department of Oral and Maxillofacial Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Irene Sulzbacher
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Edgar Selzer
- University Clinic of Radiotherapy, Medical University of Vienna, Vienna, Austria
- Corresponding author. E-mail:
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Sarcomas of the Oral and Maxillofacial Region: Analysis of 26 Cases with Emphasis on Diagnostic Challenges. Pathol Oncol Res 2018; 25:593-601. [PMID: 30382526 DOI: 10.1007/s12253-018-0510-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022]
Abstract
Sarcomas of the Oral and Maxillofacial Region (SOMR) are rare lesions which pose diagnostic and management challenges. We analyzed 26 cases of SOMR with respect to clinical presentation, histopathological subtype, treatment modalities, recurrence, and treatment outcome. In our series, Osteosarcoma (OS) was the most common type of sarcoma (7 cases), followed by 5 cases of Ewing's Sarcoma (ES), 3 cases each of Chondrosarcoma (CS) and Leiomyosarcoma (LMS), 2 cases each of Malignant Peripheral Nerve Sheath Tumor (MPNST), Pleomorphic Undifferentiated Sarcoma (PUS), Myeloid Sarcoma (MS)and Rhabdomyosarcoma (RMS). Surgery was the primary treatment modality in most cases and was combined with adjuvant chemo/ radiotherapy in few cases. 24 of the 26 cases were followed up for an average period of 40.67 months. Adverse disease outcomes like recurrence were seen in 2 cases whereas death due to the disease was reported in 7 cases. In view of the diagnostic challenges faced in SOMRs, it appears practical to stress on the underlying genetic aspects of the disease process rather than histological subtyping to improve disease outcome.
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9
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Jeong HI, Lee MJ, Nam W, Cha IH, Kim HJ. Osteosarcoma of the jaws in Koreans: analysis of 26 cases. J Korean Assoc Oral Maxillofac Surg 2017; 43:312-317. [PMID: 29142865 PMCID: PMC5685860 DOI: 10.5125/jkaoms.2017.43.5.312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/29/2017] [Accepted: 10/04/2017] [Indexed: 11/11/2022] Open
Abstract
Objectives In order to assess clinical behavior, response to treatment, and factors influencing prognosis of Korean patients with osteosarcoma of the jaws (OSJ). Materials and Methods A retrospective study of clinical, and pathological records of 26 patients with OSJ treated at the Department of Oral and Maxillofacial Surgery in Yonsei University Dental Hospital from 1990 to March 2017. Results Of 26 patients, there were 9 men (34.6%) and 17 women (65.4%). Twenty-one of 26 patients had osteosarcoma of the mandible, and 5 of 26 patients had osteosarcoma of the maxilla. The histopathology of OSJ is highly variable, ranging from chondroblastic type (6 out of 26), osteoblastic type (10 out of 26), fibroblastic type (2 out of 26), to the rare variants like mixed type, small cell osteosarcoma types and more. All patients underwent gross total excision and only a few patients underwent neoadjuvant chemotherapy. Postoperative chemotherapy was given to most of the patients as adjuvant treatment or in combination with radiotherapy. The overall survival rate was 73.1% with an overall 2-year survival rate of 83.3%. The overall 5-,10-,15-year survival rates in this study were 73.5%, 73.5%, 49%, respectively. Using Kaplan-Meier analysis with log rank tests, the size of tumor (T-stage), and resection margins were found to affect the survival rate significantly. The chemotherapy was not significantly associated with improved survival rate. Conclusion Surgical resection with a clear margin is the most important factor in disease survival. The role of chemotherapy and radiotherapy in OSJ remains controversial, and deserves further studies.
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Affiliation(s)
- Hye-In Jeong
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Mi Jee Lee
- Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea.,Colonical War Memorial Hospital, Ministry of Health, Suva, Fiji
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.,Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.,Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.,Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea
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10
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Yamamoto-Silva FP, Silva BSDF, Batista AC, Mendonça EFD, Pinto-Júnior DDS, Estrela C. Chondroblastic osteosarcoma mimicking periapical abscess. J Appl Oral Sci 2017; 25:455-461. [PMID: 28877285 PMCID: PMC5595119 DOI: 10.1590/1678-7757-2016-0424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/04/2016] [Indexed: 11/28/2022] Open
Abstract
Lesions of non-endodontic origin may mimic periapical abscess. Osteosarcoma is a rare malignant lesion.
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Affiliation(s)
| | | | - Aline Carvalho Batista
- Universidade Federal de Goiás, Departamento de Ciências Estomatológicas, Goiânia, GO, Brasil
| | | | | | - Carlos Estrela
- Universidade Federal de Goiás, Departamento de Ciências Estomatológicas, Goiânia, GO, Brasil
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11
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Li BB, Zhang JY, Gao Y. Chondroblastic osteosarcoma arising in the maxilla mimicking the radiographic and histological characteristics of cemento-osseous lesions: A case report. Mol Clin Oncol 2017; 6:733-736. [PMID: 28529749 DOI: 10.3892/mco.2017.1219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/10/2017] [Indexed: 01/25/2023] Open
Abstract
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.
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Affiliation(s)
- Bin-Bin Li
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing 100081, P.R. China
| | - Jian-Yun Zhang
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing 100081, P.R. China
| | - Yan Gao
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing 100081, P.R. China
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König M, Osnes TA, Lobmaier I, Bjerkehagen B, Bruland ØS, Sundby Hall K, Meling TR. Multimodal treatment of craniofacial osteosarcoma with high-grade histology. A single-center experience over 35 years. Neurosurg Rev 2016; 40:449-460. [PMID: 27858303 DOI: 10.1007/s10143-016-0802-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/06/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
Abstract
High-grade craniofacial osteosarcoma (CFOS) is an aggressive malignancy with a poor prognosis. Our goals were to evaluate treatment outcomes in those treated at a single referral institution over 35 years and to compare our results to the available literature. A retrospective analysis of all 42 patients treated between 1980 and 2015 at Oslo University Hospital, Norway, identified in a prospectively collected database, was conducted. Mean follow-up was 79.6 months. Overall survival at 2 and 5 years was 70.5 and 44.7%, respectively. The corresponding disease-specific survival rates were 73.0 and 49.8%. Treatment was surgery only in eight cases. Additional therapy was administered in 34 patients: chemotherapy in nine, radiotherapy in seven, and a combination of these in 18 cases. Stratified analysis by resection margins demonstrated significantly better survival at 2 and 5 years after radical surgical treatment. Neoadjuvant chemotherapy and subsequent adequate surgery resulted in better survival than surgery alone. Half of the patients either had a primary or familial cancer predisposition. This is the largest single-center study conducted on high-grade CFOS to date. Our experience indicates that neoadjuvant chemotherapy with complete surgical resection significantly improved survival, compared to surgery alone.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, Oslo, 0424, Norway. .,Department of Neurology, Ostfold Hospital Trust, 300, Gralum, 1714, Norway. .,Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.
| | - Terje A Osnes
- Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.,Department of Otorhinolaryngology, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway
| | - Ingvild Lobmaier
- Department of Pathology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Øyvind S Bruland
- Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.,Department of Oncology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Kirsten Sundby Hall
- Department of Oncology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Torstein R Meling
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, Oslo, 0424, Norway.,Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway
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13
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Mahajan A, Vaish R, Desai S, Arya S, Sable N, K D'cruz A. Gnathic Osteosarcoma: Clinical, Radiologic, and Pathologic Review of Bone Beard Tumor. J Glob Oncol 2016; 3:823-827. [PMID: 29244987 PMCID: PMC5735964 DOI: 10.1200/jgo.2016.006494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Abhishek Mahajan
- All authors: Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Richa Vaish
- All authors: Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Subhash Desai
- All authors: Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Supreeta Arya
- All authors: Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Nilesh Sable
- All authors: Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anil K D'cruz
- All authors: Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra, India
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14
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Venkatesh K, Priyanka T, Rukmini NS, Bisanna J. Chondroblastic Variant of Osteosarcoma of Mandible: Report of a Rare Case. J Clin Diagn Res 2016; 10:ED12-4. [PMID: 27656455 DOI: 10.7860/jcdr/2016/20150.8341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/07/2016] [Indexed: 11/24/2022]
Abstract
Osteosarcoma (OS), a common malignant tumour of the long bones, is rarely seen in the craniofacial region (5-8%). Though it's aetiology is unknown, previous radiotherapy, Pagets disease, Retinoblastoma and benign bone lesions such as fibrous dysplasia are considered as predisposing factors. It is seen commonly in adults between the third and fourth decades of life, in the Gnathic location mandible. We report a rare case of chondroblastic variant of OS of the right mandible, in a 35-year-old male, who underwent right segmental mandibulectomy with fibular graft reconstruction and is having disease free survival one and half years post surgery. Craniofacial OSs, are considered a separate category in view of their low histologic grade, less frequent metastases and better prognosis. Hence the diagnosis of this variant is important. This case is reported because of its rarity and typical histopathological features.
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Affiliation(s)
- Kusuma Venkatesh
- Professor, Kempegowda Institute of Medical Sciences , Bangalore, Karnataka, India
| | - Tushar Priyanka
- Post Graduate Cum Tutor, Kempegowda Institute of Medical Sciences , Bangalore, Karnataka, India
| | | | - Jagannath Bisanna
- Associate Professor Department of ENT, Kempegowda Institute of Medical Sciences , Bangalore, Karnataka, India
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15
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Qari H, Hamao-Sakamoto A, Fuselier C, Cheng YSL, Kessler H, Wright J. Phosphaturic Mesenchymal Tumor: 2 New Oral Cases and Review of 53 Cases in the Head and Neck. Head Neck Pathol 2016; 10:192-200. [PMID: 26577211 PMCID: PMC4838976 DOI: 10.1007/s12105-015-0668-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/04/2015] [Indexed: 01/03/2023]
Abstract
Phosphaturic mesenchymal tumor (PMT) is a rare neoplasm that secretes fibroblast growth factor-23 (FGF-23) and causes oncogenic osteomalacia. It occurs in adults with equal gender distribution and the most common location is the lower extremities, followed by the head and neck. Besides osteomalacia, the clinical presentation includes bone pain and multiple bone fractures. Microscopic features consist of spindle cells, multinucleated giant cells, and calcifications embedded in a chondromyxoid matrix. Laboratory findings indicate normal calcium and parathyroid levels, hypophosphatemia, and increased levels of FGF-23 that usually revert to normal after surgical removal. Due to its rarity, the purpose of the study was to report 2 new oral cases of PMT and to review the literature in the head and neck. The first case occurred in the gingiva and had been present for 6 years. The second case was a recurrence of a previously diagnosed PMT in the right mandible that metastasized to the lung and soft tissue. The literature review included 53 cases in the head and neck. There was a predilection for extra-oral sites (76%) compared to intra-oral sites (24%) with paranasal sinuses considered the most common location (38%) followed by the mandible (15%). There were 9 recurrences that included 3 malignant cases indicating a potentially aggressive tumor. Due to the indeterminate biological behavior of PMT and its rarity, a comprehensive evaluation of medical, laboratory, radiographic, and histological findings are crucial for a definitive diagnosis and treatment.
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Affiliation(s)
- Hiba Qari
- Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, 3302 Gaston Avenue Room # 214, Dallas, TX, 75246, USA.
| | - Aya Hamao-Sakamoto
- Oral and Maxillofacial Surgery Division, Department of Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9109, USA
| | | | - Yi-Shing Lisa Cheng
- Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, 3302 Gaston Avenue Room # 214, Dallas, TX, 75246, USA
| | - Harvey Kessler
- Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, 3302 Gaston Avenue Room # 214, Dallas, TX, 75246, USA
| | - John Wright
- Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, 3302 Gaston Avenue Room # 214, Dallas, TX, 75246, USA
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16
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Abstract
Osteosarcoma (OS), the commonest malignancy of osteoarticular origin, is a very aggressive neoplasm. Divergent histologic differentiation is common in OS; hence triple diagnostic approach is essential in all cases. 20% cases are atypical owing to lack of concurrence among clinicoradiologic and pathologic features necessitating resampling. Recognition of specific anatomic and histologic variants is essential in view of better outcome. Traditional prognostic factors of OS do stratify patients for short term outcome, but often fail to predict their long term outcome. Considering the negligible improvement in the patient outcome during the last 20 years, search for novel prognostic factors is in progress like ezrin vascular endothelial growth factor, chemokine receptors, dysregulation of various micro ribonucleic acid are potentially promising. Their utility needs to be validated by long term followup studies before they are incorporated in routine clinical practice.
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Affiliation(s)
- Neelam Wadhwa
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, New Delhi, India,Address for correspondence: Dr. Neelam Wadhwa, Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, New Delhi - 110 095, India. E-mail:
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17
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Wick MR, McDermott MB, Swanson PE. Proliferative, reparative, and reactive benign bone lesions that may be confused diagnostically with true osseous neoplasms. Semin Diagn Pathol 2014; 31:66-88. [DOI: 10.1053/j.semdp.2013.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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