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Osteosarcoma
Most common primary malignancy of bone (non- hematopoietic)
a malignancy of mesenchymal cells that have the ability to produce osteoid or immature bone
intramedullary (majority)
juxtacortical (small number)
extraskeletal (rarely)
origin
uncommon(6% to 8% of all osteosarcomas)
Osteosarcomas of the jaws
young children to the elderly
most often in the third and fourth decades of life.(The mean age about 33 years)
a slight male predominance
maxilla = mandible
Maxillary lesions: more commonly in the inferior portion (alveolar ridge, sinus floor, palate) > the superior aspects (zygoma, orbital rim).
Mandibular tumors :more frequently in the posterior body and horizontal ramus >the ascending ramus
The radiographic findings
vary from:1.dense sclerosis2.a mixed sclerotic radiolucent lesion 3.an entirely radiolucent process
The peripheral border ………….usually ill-defined
Osteogenic Sarcoma
buccal and lingual expansion of the mandible.
The expansion was hard and the patient complained
only of pain. The clinical features are
obviously non-specific.
pronounced clinical swelling
The radiograph shows remarkably little change except for a diffuse opacity in the bicuspid area
Here is another osteosarcoma characterized by diffuse opacity distal to the molar tooth.
The patient presented complaining of painit would certainly be easy to mistake this malignancy for an inflammatory condition involving the fully crowned tooth.
The degree of opacity is dependent upon the amount of mineralized bone produced by the tumor
In some instances, the earliest radiographic feature represents peculiar widening of the periodontal ligament space.
This 36 year-old female had slow swelling for the past four months and only minimal loosening of the involved teeth.
Certainly, the pattern of bone loss is not typical for periodontal disease.
the typical radiographic feature of osteosarcoma as a "sun ray" effect well illustrated in this image
"sun ray" effect
Some osteosarcomas may even display a moderately well demarcated border
although the lesion is predominantly radiolucent, one can identify globular opacities.
root resorption
widening of the mesial periodontal ligament space
21 year-old female
pain and swelling in the molar area
diffuse opacity involving the maxillary sinus
The molar teeth tested non-vital
The second molar was extracted and the socket appeared to be filling in nicely; however, her symptoms continued
The first molar was then extracted eventually a biopsy revealed osteosarcoma
are mistaken for inflammatory disease
Extraction sites in malignant tumors often appear to heal rapidly because they fill quickly with proliferating malignancy
Histopathologic Features
The essential microscopic criterion is the direct production of osteoid by malignant mesenchymal cells
The tumor cells : 1.relatively uniform round cells 2.spindle-shaped cells 3.highly pleomorphic cells with bizarre nuclear and cytoplasmic shapes
In this case, the stroma is loose but the cells are malignant and there is considerable heavily mineralized osseous tissue being formed
histopathologic subtypes
♦ Osteoblastic♦ Chondroblastic♦ Fibroblastic
do not have any great bearing on the prognosis.
Chondroblastic osteosarcomas ........ a substantial proportion of all osteosarcomas of the jaws
spindling malignant fibrous stroma with formation of poorly calcified, markedly irregular bone trabeculae
Osteogenic Sarcoma (Chondroblastic Type)
Osteogenic SarcomaClass Slide Osteoblastic
Osteoblastic type
Tumor Necrosis