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OSTEOSARCOMA

(OSTEOGENIC SARCOMA)

Introduction
Definition
Clinical features
Radiographic features
Histological variants
Treatment and prognosis

DEFINITION
Osteosarcoma is an aggressive malignant neoplasm
arising from primitive transformed cells of mesenchymal
origin (and thus a sarcoma) that exhibit osteoblastic
differentiation and produce malignant osteoid.
It is the most common histological form of primary bone
cancer in age 12-25yrs.
That have the ability to produce osteoid or immature
bone, with an incidence of 0.7 per million.

OSTEOSARCOMA
(OSTEOGENIC SARCOMA)
It is the most common primary neoplasm of bone, but
overall is rare, especially in the jaws.
Etiology
The exact etiologic factors for the development of
osteosarcoma are unknown.
Osteosarcomas are associated with mutations in the
retinoblastoma gene (RB) and p53
Irradiation, trauma or pre-existing bone disorder such as
Paget`s disease or fibrous dysplasia might be predisposing
factors

CLASSIFICATION
1. According to clinical appearance:
Conventional (endosteal) osteosarcoma
the tumor arises from the osteoblasts in the endosteum and
grows within the marrow spaces.
It penetrates or partially destroys the overlying cortex to
extend beneath the periosteum.
Parosteal osteosarcoma
this uncommon variant of osteosarcoma has somewhat better
prognosis.
The tumor grows from the external surface of the bone.
These tumors tend to grow slowly and metastasize late.

CONVENTIONAL OSTEOSARCOMA

2. According to radiographic picture:


Osteoblastic (sclerosing) type
Osteolytic type
3. According to histolo gic features:
Osteoblastic osteosarcoma.
Fibroblastic osteosarcoma.
Chondroblastic osteosarcoma.
Telangiectatic osteosarcoma.

CLINICAL FEATURES
Age: young age.
Sex: males more than females.
Site: This lesion mainly affects the long bones and is rare
intraorally.
Orally the mandible is more affected than the maxilla.
Features
Pain and swelling of the affected bone.
History of trauma.
Osteosarcoma of the jaw is a rapidly invasive lesion, there

RADIOGRAPHIC FEATURES
The radiographic features of osteosarcoma are variable
depending on the degree of bone formation in the tumor.
In the osteoblastic or sclerosing type irregular foci of
radiopacity intermingled with areas of radiolucency is
noted.
In the osteolytic type irregular radiolucent area with no
radiopacities can be seen.

RADIOGRAPHIC FEATURES
In rapidly growing tumors when the periosteum is
raised, specules of new bone are laid down
perpendicular to the cortex giving the sun ray
appearance
At the junction between raised and normal
periosteum a wedge of reactive bone referred to as
Codman`s triangle may develop.

PERIAPICAL RADIOGRAPH
Symmetrical widening of the
periodontal ligament space of one or
more teeth is considered an early and
diagnostic feature of osteosarcoma

WIDENING OF PERIODONTAL LIGAMENT


SPACE IS AN EARLY SIGN OF OSTEOSARCOMA

HISTOPATHOLOGY
Osteosarcomas originate from bone cells (osteoblasts)
that are variable in appearance and have wide
potentialities.
The microscopic appearance of the tumor is therefore
widely variable, even within an individual lesion.
The lesion consists of:
Collections of atypical neoplastic osteoblasts showing
considerable variation in size and shape, they may be
small and angular or large and hyperchromatic.
Mitoses may be prominent, particularly in the most
cellular areas of the tumor.

The formation of tumor osteoid or bone is a diagnostic


histologic criterion of the lesion.
The neoplastic cells do not rim the tumor bone in the
manner seen in normal or reactive bone.
The trabeculae of tumor bone tend to be delicate and
irregularly arranged.

HISTOPATHOLOGY
Osteoblastic osteosarcoma is a variant of osteosarcoma
showing extensive formation of tumor osteoid and bone.
Fibroblastic osteosarcoma shows the tendency of the
tumor cells to form varying amounts of collagen.
Tumour osteoid and bone are sparse or absent.
Chondroblastic osteosarcoma is an aggressive variant of
osteosarcoma in which the tumor cells form malignant
chondroid tissue.
Telangiectatic osteosarcoma is a tumor characterized by
the presence of large blood filled cystic spaces.

TREATMENT & PROGNOSIS

TREATMENT MEASURES FOR OSTEOSARCOMA


OF JAW BONES INCLUDE THE FOLLOWING:

- Any combination of chemotherapy, radiation


therapy, and
invasive procedures, maybe used to treat the tumor .
- Wide surgical excision of Jaw Osteosarcoma and
removal of the entire lesion is the standard
treatment mode. If the tumor is not fully removed,
then it will recur .

*After surgical removal of the tumor, reconstructive surgical


procedures may be planned to correct facial defects and restore
the face
* Embolization of the tumor is used to provide temporary relief
from the symptoms, and reduce blood loss during a surgical
procedure
* Post-operative care is important: A minimum activity level is to
be ensured, until the surgical wound heals

REFERENCE
1. Oral & Maxillofacial Pathology - Saunders 2 edition
2. Cawsons essentials of oral pathology and oral medicine
3. Regezi oral pathology- 5th edition
4. PubMed

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