Osteosarcoma of jaw: Diagnosis and treatment challengers

Gustavo Rodrigues Almeida, Bruna Danielli Costa Rocha, Nancy Alfieri Nunes


Introducion: Osteosarcoma is a primary malignant bone tumor most commonly found in long bones. However, in the oral cavity it mainly affects the ramus and angle of the mandible. Objetive: To present a case of osteolytic osteosarcoma of the mandible and discuss the difficulties of diagnosis and treatment. Case Report: A 22-year-old white female patient, non-smoker and non-drinker attended the stomatology service with complaints of increased volume on the right side of the mandible, exhibiting premolar and molar mobility in that area.Periapical and occlusal radiographs were performed and showed presence of radiolucent area and floating teeth, confirmed by a panoramic radiography showing involvement of the mandibular ramus. Two biopsies were performed in the region with inconclusive results for malignancy. The diagnostic hypothesis was osteosarcoma. A CT scan showed bone loss, floating teeth and involvement of areas adjacent to the tumor lesion and lymph nodes. The patient was referred to the oncology hospital and a frozen section biopsy was conclusive for osteosarcoma, with removal of the base and most of the right and left mandible ramus, followed by reconstruction with titanium plate. The tumor recurred and a new surgery, radiotherapy and chemotherapy were performed in an attempt to improve the clinical condition, with failure and death after four years of initial diagnosis and tumor mutation for rhabdomyosarcoma. Conclusion: Imaging and even histopathological outpatient exams were not able to promote the final diagnosis of osteosarcoma, impairing treatment and favoring recurrence and patient death.


Key words: Osteosarcoma. Bone tumor. Diagnostic imaging.


Osteosarcoma. Bone tumor. Diagnostic imaging.

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- Nthumba PM. Osteosarcoma of the jaws: a review of literature and a case report on synchronous multicentric osteosarcomas. World J Surg Oncol. 2012 Nov [acesso em 2019 Jun 10]; 10: 240-245. Disponível em: https://wjso.biomedcentral.com/articles/10.1186/1477-7819-10-240

- Wang S, Shi M, Yu Q. Osteosarcoma of the jaws: Demographic and CT imaging features. Dentomaxillofac Radiol. 2012 Jan [acesso em 2019 Jun 10]; 41 (1): 37-42. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520269

- Cabral LA,Werkman C Brandao AA, Almeida J. Imprint cytology of osteosarcoma of the jaw: a case report. J Med Case Rep.2009 Dec [acesso em 2019 Jun 8].; 3 (1): 9327.Disponível em: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-3-9327

- Soares RC, Smith AF, Souza LB, ALV Santos, Pinto LP. Osteosarcoma of mandible initially resembling lesion of dental periapex: a case report. Rev Bras Otorrinolaringol. 2005 Apr [acesso em 2019 Jun 8];71 (2): 242-245.Disponível em: http://www.scielo.br/pdf/rboto/v71n2/a21v71n2.pdf

- Arora P, F Rehman, Francoise KL, M. Kalra Osteosarcoma of mandible: Detailed radiographic assessment of the case. Contemp Clin Dent. 2013 Jul / Aug [acesso em 2019 Jul 5; 4 (3): 382-385. Disponível em: http://www.contempclindent.org/article.asp?issn=0976-237X;year=2013;volume=4;issue=3;spage=382;epage=385;aulast=Arora

- Taking D Dhillon M Thayath MS Zaidi I, S. Singh Central telangiectatic osteosarcoma of the mandible in the Pediatric Patient: The Rarity. J Clin Diagn 2016 [acesso em 2019 Jun 8]; 10 (12): XD01-XD03. Disponível em: https://www.jcdr.net/article_fulltext.asp?id=9066

- Kimura Y, K Tomihara, Tachinami H, S Imaue, Nakamori K, K Fujiwara et al. Conventional osteosarcoma of the mandible successfully treated with radical surgery and adjuvant chemotherapy after responding poorly to chemotherapy neoadjuvant: a case report. J Medical Case Rep. 2017 [acesso em 2019 Jun 10]. 11: 210-215. Disponível em: https://doi.org/10.1186/s13256-017-1386-0

- Ribeiro AL,Noble RM, Junior SMA, Souza PARS, Junior NGS, Pine JJV. The importance of an early accurate diagnosis and evaluation in the tumor treatment of mandibular osteosarcoma. Rev Ciênc Dental (Online), Porto Alegre in 2010. [acesso em 2019 Jun 6]; 25 (3): 319-324. Disponível em: http://www.scielo.br/scielo.php?script=sci_abstract&pid=S1980-65232010000300020&lng=pt&nrm=iso&tlng=pt

- Moghadam SA, Razavi ANE, Zalani SS. Prevalence of sarcoma in Head and Neck Cancer Center in Major IRAN- A 10-Year Study. Iran J Otorhinolaryngol. 2019 Mar [acesso em 2019 Dec 10].; 31 (103): 97-102. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/30989075

- Desai D Siddharth P, P Jeergal, KA, Saini R. Fibroblastic variant of osteosarcoma: a challenge in diagnosis & management. Open Dent J. 2010 [acesso em 2019 Jul 11]; 4: 211-217. Disponível em: https://benthamopen.com/contents/pdf/TODENTJ/TODENTJ-4-211.pdf

- Elkordy MA ElBaradie TS ElSebai HI ElWahab Amin AA Khairalla MS. Osteosarcoma of the jaw: Challenges in the diagnosis and treatment. Egyptian J Nat Cancer Institute 2018 [acesso em 2019 Jul 10]; 30: 7-11. Disponível em: https://www.sciencedirect.com/science/article/pii/S1110036218300074?via%3Dihub

- Lin Y, Jewell BE, Gingold J, Lu G, Zhao R, Wang L, Osteosarcoma: Pathogenesis Molecular Modeling iPSC. Trends Mol Med. 2017 Aug [acesso em 2019 Jun 10]; 23 (8): 737-755. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558609/

- Padilla, AM Valerie. The spectrum of osteosarcoma gnathic: caveats for the clinician and the pathologist. Head Neck Pathol. 2011 Mar [acesso em 2019 Jul 13]; 5 (1): 92-9. Disponível em:https://doi.org/ 10.1007 / s12105-010-0218-y

- Lee YY, tassel PV Nauert C AK Raymond, J. Eideken Cranofacial osteosarcomas: plain film, CT and MR findings in 46 cases. Am J Roentg. 1988 Jun [acesso em 2019 Dec 18]; 150: 1397-1402. Disponível em: https://www.ajronline.org/doi/pdfplus/10.2214/ajr.150.6.1397

- Noguchi T,Sugiura Y, Okada N, Tshuchiya Y Hyasaka J, K Sasaguri, S et al Sarukawa. The modified preauricular and transmandibular approach for surgical management of osteosarcoma of the mandibular condyle Within the space and infratemporal fossa masticator: a case report. J Med Case Rep. 2019 Mar [acesso em 2019 Jul 13]; 13 (1): 58-63. Disponível em: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-019-1975-1

- Tossato OS, AC Pereira Cavalcanti MGP. Osteosarcoma and chondrosarcoma: radiographic differentiation by means of computed tomography. Pesqui Odontol Bras. São Paulo 2002 [acesso em 2019 Jul 16]; 16 (1): 69-76. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1517-74912002000100012

- Valente R, Abreu TC, Real FH. Osteosarcoma Jaw - Case Report. Rev Cir Traumatol Bucomaxilofac. [Online] 2011[acesso em 2019 Sep 8];11 (4): 37-42. Disponível em: http://revodonto.bvsalud.org/scielo.php?script=sci_arttext&pid=S1808-52102011000400007

- Thariat JSchouman A, Brouchet J Sarini RC, Miller M, Reychler I et al. Osteosarcomas of the mandible: are they different from other tumor sites.Crit Rev Oncol Hematol.2012 [acesso em 2019 Jul 13]; 82 (3): 280-95. Disponível em: https://www.sciencedirect.com/science/article/pii/S0923753419371339

- Seng DWu J, Fang Q, Liu F. Prognosis of osteosarcomas in the mandible: 15-year experience of 55 patients. Medicine (Baltimore) 2019 [acesso em 2020 Jan 4]; 98: 1. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30608407-prognosis-of-osteosarcomas-in-the-mandible-15-year-experience-of-55-patients/

- Lukschal LF, Barbosa RMLB, Alvarenga RL, Horta MCR. Osteosarcoma in the maxilla: case report. Rev Port Estomatol Med Dent Cir Maxilofac.2013 [acesso em 2019 Jul 14]; 54 (1): 48-52. Disponível em: https://www.elsevier.es/en-revista-revista-portuguesa-estomatologia-medicina-dentaria-330-articulo-errata-do-artigo-osteossarcoma-em-S1646289013001532

- Bertin H, Moil R, R Brion, J Amiaud, Battaglia S, Moreau Aet al. Jaw osteosarcoma models in mice: first description. J Transl Med. 2019 [acesso em 2020 Jan 4]; 17: 56. Disponível em: https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-019-1807-5

- Lee YY, tassel PV Nauert C AK Raymond, J. Eideken Cranofacial osteosarcomas: plain film, CT and MR findings in 46 cases. Am J Roentg.1988 Jun [accesso em 2020 Jan 4]; 150: 1397-1402. Disponível em: https://www.ajronline.org/doi/pdf/10.2214/ajr.150.6.1397

DOI: https://doi.org/10.15600/2238-1236/fol.v30n1p123-132

 A Revista da Faculdade de Odontologia de Lins e sua Comissão Editorial tem como alvo alterar sua periodicidade para quadrimenstral, para isso conta com a comunidade de pesquisadores para submissão de artigos científicos, revisões estruturadas, casos clínicos e resenhas.

ISSN Eletrônico: 2238-1236