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De Novo Osteogenic Sarcoma of Mastoid Bone

De Novo Osteogenic Sarcoma of Mastoid Bone The most common primary malignant tumor of the bone is osteosarcoma. Primary involvement of the craniofacial bones in osteosarcoma is relatively rare. The mandible and the maxillae are the most commonly affected bones of the head. Here, we report a rare case of de novo high-grade osteogenic sarcoma of the mastoid region of the temporal bone and discuss the diagnostic and therapeutic properties. Key words: osteosarcoma, mastoid bone Introduction diagnosis was osteogenic sarcoma of the mastoid bone (Fig. 2). He was referred to the Department of Osteosarcomas are the most common primary malig- Medical Oncology of Ybni Sina Hospital, Ankara nant tumors of the bone. The appendicular skeleton, University, Faculty of Medicine, in June 2001 for in particular the long bones of the limbs, especially further treatment. The patient had none of the predis- the distal end of the femur and the proximal end of posing factors, such as Paget’s disease of the bone, the tibia are the most common primary sites. radiotherapy or brous dysplasia. There was no Osteosarcomas of the craniofacial bones are relatively abnormality on general physical examination except a rare and represent less than 10% of all osteosar- left postauricular incision scar. Hematological and comas. The most commonly affected bones of the biochemical parameters, including serum alkaline head are the mandible, followed by the maxilla. phosphatase, were normal. Postoperative CT scan Osteosarcomas of extragnathic craniofacial bones are showed the cavitation due to surgical removal and very rare, constituting fewer than 2% of all osteosar- there was no sign of macroscopic residual tumor 1,2 comas. We report a rare case of de novo osteogenic (Fig. 1b). No metastatic lesions were noted on chest sarcoma of the mastoid region of the temporal bone. CT and bone scintigraphy. The histopathological slides were revised and the diagnosis of high-grade medullary osteosarcoma was con rmed (Fig. 2). The Case report combination chemotherapy regimen that we use for A 20-year-old man was admitted to a private medical conventional osteosarcoma, consisting of ifosfamide, center in May 2001, with a history of extensive painful adriamycin, high-dose methotrexate, and cisplatin, swelling over the left temporo-mastoid region. He was was applied as adjuvant treatment. Adjuvant also suffering from hearing loss in the left ear. chemotherapy was completed and the patient has Computed tomography (CT) scan of the mastoid been alive for 11 months without any recurrence of showed a radio-dense mass with soft tissue density the disease. areas which caused destruction of mastoid bone, was extending to the external auditory canal. In addition, Discussion there was a bony fragmentation in the lesion, and loss of aeration in the mastoid bone (Fig. 1a). The tumor We present an aggressive medullary osteosarcoma was excised totally in the hospital. Histopathological arising from an unusual site, the mastoid region of Correspondence to: Abdullah Büyükçelik, MD, Department of Medical Oncology, Ybni Sina Hospital, Faculty of Medicine, Ankara University, Syhhiye , Ankara 06100, Turkey. Tel.: +90–312–310–3333, Ext. 2132 & 2644; Fax: +90–312–312–1650; GSM: +90–535–894–9503; E-mail: drabdullah@superposta.com ISSN 1357–714X print/ISSN 1369–1643 online/02/0200079–03 © Taylor & Francis Ltd DOI: 10.1080/1357714021000022186 80 Ipykdogan et al. Fig. 1. Computed tomography of temporal bones showed a mass of soft tissue that contained bone fragments, obliterating external auditory meatus and subcutaneous fatty tissue: destruction of mastoid bone and the loss of aeration in mastoid cells on the left side (a) and the cavitation in mastoidal bone after surgery (b). the temporal bone, developed in a patient without grade surface bone tumor with a better prognosis 5,6 any predisposing condition. than medullary osteogenic sarcoma. Tumors of the mastoidal bone are uncommon, Nora et al. reported a series of 21 patients with 1 2 with the exception of osteomas. Primary malignant osteosarcomas of extragnathic craniofacial bones. tumors of this bone are very rare. Osteogenic They revised the archives of Mayo Clinic containing sarcoma, which is the most common primary bone nearly 7000 bone tumors, including 1000 osteosar- tumor, rarely occurs in the facial and the cranial comas, and only 21 cases affecting extragnathic cran- bones. It may be located in the mandible and iofacial bones were found.These tumors were located 2–4 maxillae, but it is very rare in the temporal bone. over the entire calvarium The usual involved site was Osteosarcomas of extragnathic craniofacial bones the occipital bone. Only one of these cases was constitute fewer than 2% of all osteosarcomas, and located at the temporo-sphenoid region. Salvatti et al. less than 0.5% of all primary bone tumors. These also presented 19 cases of osteosarcoma of the skull, osteosarcomas may be ‘classic’ aggressive medullary only one of which was located at the temporo-pari- type or parosteal osteogenic sarcoma, which is a low- etal bone region. Sharma et al. reported a case of Osteogenic sarcoma of mastoid bone 81 Fig. 2. Histopathological examination of the mass in mastoid bone demonstrated many eosinophilic lace-like osteoid accumulations with atypical osteoblasts surrounding them HE (200x). in osteosarcoma may increase the importance of classic osteogenic sarcoma of the temporal bone. effective neoadjuvant and adjuvant chemotherapy. Seely and Gates reported two cases of parosteal osteosarcoma arising from mastoid bone, and Kumar et al. also reported eight patients with parosteal References osteosarcoma of cranial bones, only two of them were 1. Malawer MM, Link MP, Donaldson SS. Sarcomas of arising from the mastoid region. bone. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds. The skull is a more common site for secondary Cancer. 5th edn. Philadelphia, PA: Lipincott-Raven, 1997: 1789–852. osteosarcomas. Paget’s disease and prior radiother- 2. Nora FE, Unni KK, Pritchard DJ, et al. Osteosarcoma apy are the most common predisposing conditions. of extragnathic craniofacial bones. Mayo Clin Proc The rate of the secondary osteosarcoma in patients of 1983; 58: 268–72. 2 7 Nora et al. and Salvati et al. were reported as six of 3. De SK, Dey DD. Tumours of the mastoid temporal 21 (28%) and seven of 19 (36.8%), respectively. In bone: with interesting cases in the paediatric age group. J Laryngol Otol 1988; 102: 582–7. these two series, the authors had not classi ed the 4. Sharma SC, Handa KK, Panda N, et al. Osteogenic cases as aggressive medullary or parosteal osteosar- Sarcoma of the temporal bone. Am J Otolar yngol 1997; comas, but the vast majority of these tumors were his- 18: 220–3. tologically described as being highly malignant. 5. Seely DR, Gates GA. Parosteal osteogenic sarcoma of the mastoid bone. Ann Otol Rhinol Laryngol 1997; 106: Parosteal osteosarcomas with typical radiological 729–32. appearance of sessile, densely ossi ed surface growth 6. Kumar R, Moser RP Jr, Madewell JE, et al. Parosteal with radiating bone spicules that blend with osteogenic sarcoma arising in cranial bones: clinical surrounding soft tissue are usually low grade lesions and radiologic features in eight patients. AJR Am J 5,6 Roentgenol 1990; 155: 113–7. and en bloc resection is curative in most cases. 7. Salvati M, Ciappetta P, Raco A. Osteosarcomas of the Medullary high-grade osteosarcoma of the craniofa- skull. Clinical remarks on 19 cases. Cancer 1993; 71: cial region carries increased risk of local recurrences 2210–6. and distant metastases. There is no reason to 8. Rosen G, Forscher C, Mankyn HJ, Selch MT. Bone manage these patients in a different way from tumors. In: Bast RC Jr, Kufe DW, Pollock RE, Weichselbaum RR, Holland JF, Frei E III, eds. Cancer conventional osteosarcomas. They should be treated medicine. 5th edn. Hamilton, London: BC Decker, in a multidisciplinary fashion, with preoperative 2000: 1870–902. chemotherapy followed by radical resection and 9. Smeele LE, Kostense PJ, van der Waal I, Snow GB. adjuvant treatment, similar to the successful treat- Effect of chemotherapy on survival of craniofacial osteosarcoma: a systematic review of 201 patients. J ment of conventional extremity osteosarcomas. Some Clin Oncol 1997; 15: 363–7. limited experiences have already appeared in the 10. Sunderasan N, Huvos AG, Rosen G, Galicich JH. 7,9,10 literature. The dif culty of radical resections in Combined-modality treatment of osteogenic sarcoma this region and limited effectiveness of radiotherapy of the skull. J Neurosurg 1985; 63(4): 562–7. 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De Novo Osteogenic Sarcoma of Mastoid Bone

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Hindawi Publishing Corporation
Copyright
Copyright © 2002 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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1357-714X
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1369-1643
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10.1080/1357714021000022186
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Abstract

The most common primary malignant tumor of the bone is osteosarcoma. Primary involvement of the craniofacial bones in osteosarcoma is relatively rare. The mandible and the maxillae are the most commonly affected bones of the head. Here, we report a rare case of de novo high-grade osteogenic sarcoma of the mastoid region of the temporal bone and discuss the diagnostic and therapeutic properties. Key words: osteosarcoma, mastoid bone Introduction diagnosis was osteogenic sarcoma of the mastoid bone (Fig. 2). He was referred to the Department of Osteosarcomas are the most common primary malig- Medical Oncology of Ybni Sina Hospital, Ankara nant tumors of the bone. The appendicular skeleton, University, Faculty of Medicine, in June 2001 for in particular the long bones of the limbs, especially further treatment. The patient had none of the predis- the distal end of the femur and the proximal end of posing factors, such as Paget’s disease of the bone, the tibia are the most common primary sites. radiotherapy or brous dysplasia. There was no Osteosarcomas of the craniofacial bones are relatively abnormality on general physical examination except a rare and represent less than 10% of all osteosar- left postauricular incision scar. Hematological and comas. The most commonly affected bones of the biochemical parameters, including serum alkaline head are the mandible, followed by the maxilla. phosphatase, were normal. Postoperative CT scan Osteosarcomas of extragnathic craniofacial bones are showed the cavitation due to surgical removal and very rare, constituting fewer than 2% of all osteosar- there was no sign of macroscopic residual tumor 1,2 comas. We report a rare case of de novo osteogenic (Fig. 1b). No metastatic lesions were noted on chest sarcoma of the mastoid region of the temporal bone. CT and bone scintigraphy. The histopathological slides were revised and the diagnosis of high-grade medullary osteosarcoma was con rmed (Fig. 2). The Case report combination chemotherapy regimen that we use for A 20-year-old man was admitted to a private medical conventional osteosarcoma, consisting of ifosfamide, center in May 2001, with a history of extensive painful adriamycin, high-dose methotrexate, and cisplatin, swelling over the left temporo-mastoid region. He was was applied as adjuvant treatment. Adjuvant also suffering from hearing loss in the left ear. chemotherapy was completed and the patient has Computed tomography (CT) scan of the mastoid been alive for 11 months without any recurrence of showed a radio-dense mass with soft tissue density the disease. areas which caused destruction of mastoid bone, was extending to the external auditory canal. In addition, Discussion there was a bony fragmentation in the lesion, and loss of aeration in the mastoid bone (Fig. 1a). The tumor We present an aggressive medullary osteosarcoma was excised totally in the hospital. Histopathological arising from an unusual site, the mastoid region of Correspondence to: Abdullah Büyükçelik, MD, Department of Medical Oncology, Ybni Sina Hospital, Faculty of Medicine, Ankara University, Syhhiye , Ankara 06100, Turkey. Tel.: +90–312–310–3333, Ext. 2132 & 2644; Fax: +90–312–312–1650; GSM: +90–535–894–9503; E-mail: drabdullah@superposta.com ISSN 1357–714X print/ISSN 1369–1643 online/02/0200079–03 © Taylor & Francis Ltd DOI: 10.1080/1357714021000022186 80 Ipykdogan et al. Fig. 1. Computed tomography of temporal bones showed a mass of soft tissue that contained bone fragments, obliterating external auditory meatus and subcutaneous fatty tissue: destruction of mastoid bone and the loss of aeration in mastoid cells on the left side (a) and the cavitation in mastoidal bone after surgery (b). the temporal bone, developed in a patient without grade surface bone tumor with a better prognosis 5,6 any predisposing condition. than medullary osteogenic sarcoma. Tumors of the mastoidal bone are uncommon, Nora et al. reported a series of 21 patients with 1 2 with the exception of osteomas. Primary malignant osteosarcomas of extragnathic craniofacial bones. tumors of this bone are very rare. Osteogenic They revised the archives of Mayo Clinic containing sarcoma, which is the most common primary bone nearly 7000 bone tumors, including 1000 osteosar- tumor, rarely occurs in the facial and the cranial comas, and only 21 cases affecting extragnathic cran- bones. It may be located in the mandible and iofacial bones were found.These tumors were located 2–4 maxillae, but it is very rare in the temporal bone. over the entire calvarium The usual involved site was Osteosarcomas of extragnathic craniofacial bones the occipital bone. Only one of these cases was constitute fewer than 2% of all osteosarcomas, and located at the temporo-sphenoid region. Salvatti et al. less than 0.5% of all primary bone tumors. These also presented 19 cases of osteosarcoma of the skull, osteosarcomas may be ‘classic’ aggressive medullary only one of which was located at the temporo-pari- type or parosteal osteogenic sarcoma, which is a low- etal bone region. Sharma et al. reported a case of Osteogenic sarcoma of mastoid bone 81 Fig. 2. Histopathological examination of the mass in mastoid bone demonstrated many eosinophilic lace-like osteoid accumulations with atypical osteoblasts surrounding them HE (200x). in osteosarcoma may increase the importance of classic osteogenic sarcoma of the temporal bone. effective neoadjuvant and adjuvant chemotherapy. Seely and Gates reported two cases of parosteal osteosarcoma arising from mastoid bone, and Kumar et al. also reported eight patients with parosteal References osteosarcoma of cranial bones, only two of them were 1. Malawer MM, Link MP, Donaldson SS. Sarcomas of arising from the mastoid region. bone. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds. The skull is a more common site for secondary Cancer. 5th edn. Philadelphia, PA: Lipincott-Raven, 1997: 1789–852. osteosarcomas. Paget’s disease and prior radiother- 2. Nora FE, Unni KK, Pritchard DJ, et al. Osteosarcoma apy are the most common predisposing conditions. of extragnathic craniofacial bones. Mayo Clin Proc The rate of the secondary osteosarcoma in patients of 1983; 58: 268–72. 2 7 Nora et al. and Salvati et al. were reported as six of 3. De SK, Dey DD. Tumours of the mastoid temporal 21 (28%) and seven of 19 (36.8%), respectively. In bone: with interesting cases in the paediatric age group. J Laryngol Otol 1988; 102: 582–7. these two series, the authors had not classi ed the 4. Sharma SC, Handa KK, Panda N, et al. Osteogenic cases as aggressive medullary or parosteal osteosar- Sarcoma of the temporal bone. Am J Otolar yngol 1997; comas, but the vast majority of these tumors were his- 18: 220–3. tologically described as being highly malignant. 5. Seely DR, Gates GA. Parosteal osteogenic sarcoma of the mastoid bone. Ann Otol Rhinol Laryngol 1997; 106: Parosteal osteosarcomas with typical radiological 729–32. appearance of sessile, densely ossi ed surface growth 6. Kumar R, Moser RP Jr, Madewell JE, et al. Parosteal with radiating bone spicules that blend with osteogenic sarcoma arising in cranial bones: clinical surrounding soft tissue are usually low grade lesions and radiologic features in eight patients. AJR Am J 5,6 Roentgenol 1990; 155: 113–7. and en bloc resection is curative in most cases. 7. Salvati M, Ciappetta P, Raco A. Osteosarcomas of the Medullary high-grade osteosarcoma of the craniofa- skull. Clinical remarks on 19 cases. Cancer 1993; 71: cial region carries increased risk of local recurrences 2210–6. and distant metastases. There is no reason to 8. Rosen G, Forscher C, Mankyn HJ, Selch MT. Bone manage these patients in a different way from tumors. In: Bast RC Jr, Kufe DW, Pollock RE, Weichselbaum RR, Holland JF, Frei E III, eds. Cancer conventional osteosarcomas. They should be treated medicine. 5th edn. Hamilton, London: BC Decker, in a multidisciplinary fashion, with preoperative 2000: 1870–902. chemotherapy followed by radical resection and 9. Smeele LE, Kostense PJ, van der Waal I, Snow GB. adjuvant treatment, similar to the successful treat- Effect of chemotherapy on survival of craniofacial osteosarcoma: a systematic review of 201 patients. J ment of conventional extremity osteosarcomas. Some Clin Oncol 1997; 15: 363–7. limited experiences have already appeared in the 10. Sunderasan N, Huvos AG, Rosen G, Galicich JH. 7,9,10 literature. The dif culty of radical resections in Combined-modality treatment of osteogenic sarcoma this region and limited effectiveness of radiotherapy of the skull. J Neurosurg 1985; 63(4): 562–7. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014

Journal

Sarcoma – Hindawi Publishing Corporation

Published: Jan 1, 2002

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