Oral and maxillofacial pathology
Low-grade central osteosarcoma of the mandible: a case study report

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Low-grade central osteosarcoma is a rare type of osteosarcoma with peculiar clinical radiographic and microscopic features. The aim of this article is to report and discuss a case of low-grade central osteosarcoma in the mandible of a 42-year-old woman. The patient reported sensing mild pain and tooth mobility for a period of 4 years, despite continuous dental treatment. Radiographic evaluation showed a mixed radiopaque/radiolucenct lesion in the body, ramus, coronoid process, and condyle of the left side of the mandible. Destruction of the mandibular cortex in the area was also observed. After incisional biopsy, the patient underwent hemimandibulectomy. Microscopic findings showed a tumor exhibiting spindle cells with nuclear hyperchromasia and no mitotic activity, irregular osteoid formation, and soft tissue infiltration. The immunohistochemical analysis of the expression of Ki-67, Cyclin B1, and PCNA proteins (cellular proliferation markers) revealed a very low Ki-67+ and Cyclin B1+ cell index (mean 7% and 3%, respectively), but a moderate number of PCNA+ cells (mean 49%). The 2 years of clinical and imaging postoperative follow-up showed no evidence of recurrence. Clinicians should be aware of these lesions, because histopathologicially low-grade central osteosarcoma may be misinterpreted as fibrous dysplasia.

Section snippets

Case report

A 42-year-old woman, who had been complaining of a mild pain and tooth mobility on the left side of the mandible for approximately 4 years, was admitted to the Head and Neck Department of the Araújo Jorge Cancer Hospital in August, 2003. During this symptomatic period, the patient had received periodontal and endodontic treatment without relief of pain. Her medical history showed no significant findings. On extraoral examination a discrete facial asymmetry and enlargement on the left side of

Primary antibodies

For an assessment of the growth fractions of the tumor, an immunohistochemical study of the expression of Ki-67 (clone MM1, Novocastra, Newcastle, UK) diluted 1:100, Cyclin B1 (clone 7A9, Novocastra) diluted 1:40, and PCNA (clone PC10; Dako, Glostrup, Denmark) 1:2000 proteins was carried out.

Immunohistochemical technique

After embedding the tissue in paraffin wax, 3-μm thick sections were obtained and collected on silane-coated glass slides. The immunohistochemical expression of Ki-67, Cyclin B1, and PCNA was performed

Immunohistochemical findings

Our quantitative analysis revealed few Ki-67+, Cyclin B1+ cells (mean 7% and 3% of the immunostained tumor cells, respectively) (Fig. 7,B and C), but a moderate number of PCNA+ cells (mean 49% of the immunostained tumor cells) (Fig. 7, A). Ki-67 and PCNA stained the nuclei, whereas Cyclin B1 predominantly stained the cytoplasm both of spindle and osteoblastic/osteocytic cells.

Discussion

Low-grade central osteosarcoma occurs within a broad age range (16 to 69 years), with peak incidence in the third or fourth decades.4, 6, 7, 8 Eighty-one percent of the lesions were located in the long bones and 15% were located in flat bones.2, 6 The LGCO are rare in the jaws, and the peak incidence occurs in the fourth decade.4, 8 Only 14 cases of low-grade central osteosarcoma of jaws, including our case, have been reported in the literature. There are 7 cases from the maxilla2, 4, 8, 27, 28

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