Osteosarcoma of the jaws: A 30-year retrospective review

Objective. This article reviews osteosarcomas of the jaws referred to the D epartment of Oral Pathology, Eastman Dental Institute, for histologic diagn osis during the 30 years from 1968 to 1998, to compare the clinical behavio r of the tumors, to assess how they differ From the reported characteristic s of tumors from other sites, and to report on observations of clinical and diagnostic significance. Study design. The clinical, radiographic, and histopathologic records of 25 patients were obtained for retrospective review. Supportive and follow-up clinical and histopathologic material was obtained from the referring clini cians. Results The mean age of presentation of the primary lesions was 36.9 years (range, 10-87 years) with a slight female predilection. The most common pre senting features were swelling, pain, ulceration, or a neurologic deficit. The radiographic appearance of the lesions was mixed with areas of radiopac ity and radiolucency. Histologically, the lesions ranged from those dominat ed by immature bony trabeculae separated by a cytologically bland stroma to high-grade, cellular lesions with regions of marked atypia and mitotic act ivity. Most had areas of chondroid formation, in addition to neoplastic ost eoid. The main complication was local recurrence. Metastasis was rare and o ccurred as a solitary process or at a late stage in the disease progression ; This was in contrast to lesions metastatic to the jaws, which were higher grade in appearance and had metastasized widely, early in the disease proc ess. Primary osteosarcoma occurring in patients with a history of radiother apy was typically more aggressive. Conclusion. Primary osteosarcomas of the jaws are a group of lesions distin ct from those occurring In the long bones. Osteosarcomas of the jaw arising in a former radiation field may be a discrete group of lesions with a more aggressive behavior pattern.