Osteosarcoma of H&N

Osteosarcoma of H&N
H. Ric Harnsberger, MD
Key Facts
Terminology
  • Definition: Malignant tumor arising from bone with ability of neoplastic cells to produce osteoid
Imaging
  • Bone CT: Shows bone tumor with both osteolytic & osteoblastic components
  • MR imaging: Best evaluates extent of osteosarcoma
    • Intramedullary and extraosseous soft tissues
  • PET/CT: Used for local recurrence and distant metastasis identification
Top Differential Diagnoses
  • Mandible-maxilla osteomyelitis
  • Mandible-maxilla metastasis
  • Ewing sarcoma
  • Langerhans cell histiocytosis
  • Mandible-maxilla osteoradionecrosis
Pathology
  • Heterogeneous mass with ossified and nonossified components
  • Chondroblastic > osteoblastic > fibroblastic
Clinical Issues
  • Mean age: 35 years
  • Prognosis depends on pathologic type, size, location, and presence of metastases
  • 5-year survival = 60%
  • Complete resection affords best chance of survival
Diagnostic Checklist
  • Osteoid matrix in tumor of mandible or maxilla suggests osteosarcoma
    • If not present, consider metastasis or osteomyelitis
  • Consider radiation-induced osteosarcoma if patient had radiation years prior
(Left) Coronal graphic shows right mandible osteosarcoma. Note associated soft tissue mass image with aggressive periosteal reaction image. (Right) Axial bone CT demonstrates large, dense mass arising from the right mandibular body. The mass has both osteoid matrix image and periosteal reaction image associated with it. This is a classic aggressive periosteal reaction associated with osteosarcoma where periosteum is lifted off perpendicular to bone. Marrow within the involved portion of the mandible is sclerotic image.
(Left) Coronal T1 C+ fat-saturated MR reveals a large, heterogeneously enhancing maxillary mass involving the alveolar ridge image, orbital floor image, and deep soft tissues of the cheek image. (Right) Coronal bone CT in the same patient shows extensive new bone formation in the matrix, which creates central low signal. The tumor is centered on the lateral wall of the right maxillary sinus image, extending into the fat pad image and nasal cavity image. Most maxillary OSa are found in the alveolar ridge, not the lateral wall as in this case.
TERMINOLOGY
Abbreviations
  • Osteosarcoma of head & neck (OSa H&N)
Synonyms
  • Osteogenic sarcoma
Definitions
  • Malignant tumor arising from bone with ability of neoplastic cells to produce osteoid
IMAGING
General Features
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Sep 20, 2016 | Posted by in HEAD & NECK IMAGING | Comments Off on Osteosarcoma of H&N

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