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

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.

Figure 1

Photograph of the patient at presentation. Note the nostrils were completely obstructed by the maxillary tumor.

Figure 2

Lateral (left) photograph, showing an obvious maxillary tumor. The mouth is maximally open, and had to be used for both feeding and breathing. The patient could only take fluids.

Figure 3

CT scans. (a) CT scan showing large synchronous maxillary and mandibular tumors. (b) Axial CT scan showing extensive maxillary tumor.

Figure 4

Surgical procedure. (a) Intra-operative picture showing defect after maxillectomy and mandibulectomy. (b) Resected specimens – maxilla and mandible.

Figure 5

Excellent cosmetic outcome. One month postoperatively, the patient could breathe normally, as well as feed on liquids and speak with little difficulty.

Figure 6

Hematoxylin and Eosin stains. (a) Magnification 100×. Fibroblastic with tumor high cellularity. Note areas of osteoid formation. (b) Magnification 400×. Fibroblastic tumor with high cellularity and nodular myxoid areas. Note moderate nuclear pleomorphism and hyperchromasia.