Osteosarcoma

Etiology • May be associated with pre-existing bone disease such as the
following: • Paget’s disease (10 to 15%) • Fibrous dysplasia (0.5%)
• Mutation/amplification of p53, c-myc, c-JUN, c-fos, MOM2, CDK4, SAS
Clinical Presentation • May present with pain paresthesia, trismus, nasal or paranasal

sinus obstruction • May masquerade as an odontogenic infection • Intraoral signs are as follows:
• Tooth mobility (vertical) • Periapical radiolucency (teeth vital) • Distal displacement of terminal molar • Jaw mass may be ulcerated.
Radiographic Findings • Early intraoral findings
• Displacement of teeth • Root resorption • Absent or attenuated lamina dura • Uniformly widened periodontal membrane space
• Later jaw bone findings • Lytic, “moth-eaten” destruction • Cortical destruction • Soft tissue extension • Erosion of mandibular canal • 25% of cases have “sunburst effect” (radiating radiopaque
spicules) Microscopic Findings
• Sarcomatous stroma • Osteoid production by neoplastic cells • Four basic patterns (no prognostic significance) are as follows:
• Osteoblastic • Fibroblastic • Chondroblastic • Telangiectatic

Diagnosis • Correlation of clinical, radiographic, pathologic findings
Differential Diagnosis • Fibro-osseous lesion • Osteomyelitis • Osteoradionecrosis • Metastatic tumor • Other form of sarcoma
Treatment • Radical ablative surgery
• Hemimandibulectomy • Partial maxillectomy ± orbital exenteration
• Adjuvant chemotherapy/radiotherapy Prognosis
• Survival ranges from 12 to 58% at 5 years • Mandibular lesions are associated with a greater survival rate
than are maxillary lesions.