Craniofacial Osteosarcoma: A case report. (2022)

Type of publication:
Conference abstract

*Venkatasami M.; *Harrison K.;

British Journal of Oral and Maxillofacial Surgery. Conference: BAOMS Annual Scientific Meeting. London United Kingdom. 60(10) (pp e63), 2022. Date of Publication: December 2022.

Introduction/Aims: Osteosarcoma is the most common primary bone tumour, with 10% of cases affecting the head and neck. Osteosarcoma occurs later in life, usually, in the 4-5th decade with a male predilection and predominantly affects the mandible; the maxilla being the second-most affected site. Prognosis is strongly dependent on negative resection margins and neoadjuvant chemo-radiotherapy in select cases. Case Description: A 58 year-old male, non-smoker, presented with a lump in his left upper jaw which occasionally bled and got caught during mastication. Previous medical history included quiescent relapsing-remitting multiple sclerosis and absent seizures. Clinical examination revealed a suspicious exophytic mass in the upper left tuberosity of the maxilla with no associated lymphadenopathy. <br/>Finding(s): Radiological investigations revealed a metabolically active left maxillary lesion with maxillary sinus destruction, representing primary malignancy with no nodal disease. Histological analysis of a punch biopsy revealed a fibrosseous lesion, referred to a sarcoma centre for interpretation. Immunohistochemistry showed AE1/AE3 and CK(MNF.116) positivity in occasional cells with a ki67 proliferation index of 60%. This was diagnostic of grade-2-3 osteosarcoma. Multidisciplinary management included neoadjuvant chemotherapy prior to total maxillectomy and dental prosthetic rehabilitation. Patient is still under follow-up. Conclusions/Clinical Relevance: This case of primary osteosarcoma of the maxilla is rare and scarcely reported in literature. Upon clinical appearance, this exophytic lesion could resemble squamous cell carcinoma, thus it is important to consider differential diagnoses, including osteosarcoma, which requires prompt and early specialist intervention to maximise the chances of negative surgical margins, which is the mainstay of treatment for disease prognosis.