Padilla Ricardo J, Murrah Valerie A
Division of Oral and Maxillofacial Pathology, Department of Diagnostic Sciences, University of North Carolina, Chapel Hill, NC, USA.
Head Neck Pathol. 2011 Mar;5(1):92-9. doi: 10.1007/s12105-010-0218-y. Epub 2010 Nov 3.
Seven expansile jaw lesions in patients ranging from 7 to 63 years are presented to illustrate diagnostic and management issues pertaining to cases ultimately proven to be gnathic osteosarcoma (GO). Six of the cases in our series were low-grade osteoblastic and one high-grade chondroblastic. None of our cases exhibited the characteristic "sunburst" radiopaque appearance described for GO. All of our cases displayed cortical expansion and one showed development of diastema. Two occurred in the maxilla and five in the mandible. Two of the patients with mandibular lesions presented initially with pain; all other patients were asymptomatic. Lack of pain resulted in a delay in diagnosis due to postponement of consultation or biopsy. Two cases underwent initial shallow non-representative biopsies, requiring a second biopsy for definitive diagnosis, further delaying treatment. Those biopsies were initially interpreted as pyogenic granuloma and peripheral ossifying fibroma, respectively. GO should always be considered in the differential diagnosis of expansile jaw lesions. Bone biopsies of lesions exhibiting pain and expansion of cortical plates should include medullary bone in order to minimize sampling error. In addition, all rapidly growing or painful exophytic bone lesions, and presumed soft tissue lesions that may involve underlying bone, should be examined histopathologically, and receive clinical and radiographic follow-up until complete resolution or healing is evident, regardless of the diagnosis. Based on the positive outcomes of the patients in our series, the prognosis of GO appears to be relatively favorable when compared to other sarcomas and osteosarcomas of long bones.
本文报告了7例年龄在7至63岁之间的颌骨膨胀性病变患者，以说明与最终确诊为颌骨骨肉瘤（GO）的病例相关的诊断和治疗问题。我们系列中的6例病例为低级别成骨细胞型，1例为高级别软骨母细胞型。我们所有病例均未表现出文献中描述的GO典型的“日光放射”不透光外观。我们所有病例均显示皮质膨胀，1例出现牙间隙增宽。2例发生在上颌骨，5例发生在下颌骨。2例下颌骨病变患者最初表现为疼痛；所有其他患者均无症状。由于未及时咨询或活检，无痛症状导致诊断延迟。2例病例最初进行了浅层非代表性活检，需要再次活检以明确诊断，进一步延误了治疗。这些活检最初分别被诊断为化脓性肉芽肿和外周骨化性纤维瘤。在膨胀性颌骨病变的鉴别诊断中应始终考虑GO。对表现出疼痛和皮质板膨胀的病变进行骨活检时应包括髓质骨，以尽量减少采样误差。此外，所有快速生长或疼痛的外生性骨病变，以及可能累及下方骨骼的疑似软组织病变，均应进行组织病理学检查，并接受临床和影像学随访，直至完全消退或愈合明显，无论诊断结果如何。基于我们系列中患者的良好预后，与其他肉瘤和长骨骨肉瘤相比，GO的预后似乎相对较好。
