Corsi Alessandro, Ungari Claudio, Riminucci Mara, Agrillo Alessandro
Professor of Pathology, Department of Molecular Medicine, Sapienza University, Rome, Italy.
Maxillofacial Surgeon, Department of Odontostomatologic Sciences, Section of Maxillofacial Surgery, Sapienza University, Rome, Italy.
J Oral Maxillofac Surg. 2017 Aug;75(8):1679-1684. doi: 10.1016/j.joms.2017.01.008. Epub 2017 Jan 18.
Osteonecrosis of the jaw (ONJ) is a well known complication in patients treated with bisphosphonates (BPs) for skeletal metastasis and multiple myeloma (MM). Few oncologic patients under treatment with BPs and with ONJ and metastasis or MM at the same site of the jaw have been described. We report here on a 54-year old white female who was treated with intra-venous zoledronic acid for skeletal metastasis of breast cancer who developed ONJ. Because of a fracture at the site of ONJ, resection of the affected segment was performed. Although metastasis was not suspected by pre-operative image analysis, histological examination revealed syncronous osteonecrosis and breast cancer metastasis in the resected mandibular segment. This case highlights that, in oncologic patients treated with BPs, ONJ may hide malignancy and that histology is the unique tool by which the diagnosis of either osteonecrosis or malignancy or both can be made definitely.
颌骨骨坏死（ONJ）是接受双膦酸盐（BPs）治疗骨转移和多发性骨髓瘤（MM）的患者中一种广为人知的并发症。很少有接受BPs治疗且患有ONJ同时在颌骨同一部位发生转移或MM的肿瘤患者被描述过。我们在此报告一名54岁的白人女性，她因乳腺癌骨转移接受静脉注射唑来膦酸治疗后发生了ONJ。由于ONJ部位发生骨折，对受累节段进行了切除。尽管术前影像分析未怀疑有转移，但组织学检查显示在切除的下颌节段中存在同步性骨坏死和乳腺癌转移。该病例突出表明，在接受BPs治疗的肿瘤患者中，ONJ可能掩盖恶性肿瘤，并且组织学是能够明确诊断骨坏死或恶性肿瘤或两者的唯一工具。
