High-grade chondroblastic and fibroblastic osteosarcoma of the upper jaw
A 62-year-old man was admitted to Maxillofacial Surgery Institute, Health Sciences Department, University of L’Aquila Italy, on May 16, 2008. Extraoral clinical examination revealed a significant swelling of the right cheek, appeared in April 2008. Patient suffered from paresthesia in the right facial side. Intraoral examination revealed a large ulcered mass in the toothless superior right arch, vestibular fornix, and palate []. The lesion bled easily and was hard in consistency. []. Panoramic radiograph [] revealed a mixed radiolucent and radiopaque area in the right maxilla with irregular and undefined borders. Computed tomography [] showed a round tumor-like mass involving the upper right alveolar process, palatal structure, and the inferior third of the maxillary sinus, with vestibular expansion accompanied by peripheral bone destruction. The lesion showed irregular high and low density areas. Regional pathological lymph nodes were not detected. Incisional biopsy was performed on May 18, 2008, with diagnosis of mixed sarcoma. Total body scintigraphy [] showed pathological tracer only in the right maxilla. Chest X-ray and hepatic ultrasonography were negative. Blood tests including serum alkaline phosphatise were normal except for leukocytosis and elevated ESR. On May 25, 2008, right subtotal maxillectomy was performed under general anesthesia with closure of the surgical area by local sliding and advanced cheek flap, using standard procedures [].\nMacroscopically tumor measured 6.5 × 5 × 4 cm. It involved alveolar and palatal structure of right maxilla []. Histologically [], the tumor showed diffuse osteoid production, chondroid, and fibroblastic proliferation. Under high-power magnification, the cells had generally round and oval hyperchromatic nuclei with inconspicuous nucleoli. The nuclear chromatin was dispersed finely, and the cytoplasmic boundaries appeared indistinct. Immunohistochemical studies revealed positive reactions for S-100 protein. Surgical margins were free, and they had no residual disease. Surgical margins were clear. Tumor was diagnosed as Stage II mixed, chondroblastic, and fibroblastic osteosarcoma (high-grade tumor without metastases). Postoperative course has been regular and uneventful. On June 10, 2009, the patient was discharged from the hospital with acceptable clinical conditions, except for numbness of the right cheek and aesthetic alteration. In view of the tumor size being greater than 6 cm, histopathological findings and the patient being older than 60 years, multimodality therapy was planned. On June 25, 2009, radiotherapy treatment was started for overall 6500 Gy. The follow-up at 2 years reveals no recurrence and the patient appears disease free [].