Detected most commonly during first 3 decades of life; Females>male; mandible 3x>maxilla

May be completely asymptomatic; some cause pain or bleeding from gingivae; bruit (pulsation) may occur

Most common multilocular radiolucency: "honeycomb" or "soapbubble"; occasional "sunburst"

May also show cyst-like or ill-defined appearance

- Any intrabony radiolucency suspected of being a hemangioma should be aspirated before surgical entrance

- Angiography may be of assistance in determining extent of lesion if hemangioma is suspected

- Surgical excision should be performed only by highly experienced surgeons: provision for hemostasis must be provided, otherwise patient could exanguinate

- Malignancy of mesenchymal cells that have the ability to produce osteoid or immature bone

- With exception of hematopoietic neoplasms, osteosarcoma is most common type of malignancy to arise in bone

- Most are intramedullary in origin, but some are peripheral (juxtacortical) and rarely extraskeletal

- In general OS arises most commonly between ages 10 and 20 years and most common location is metaphyseal regions of distal femur and proximal tibia; male>females

- Older patients more often exhibit axial skeleton and skull involvement

- Paget's disease of bone and previous irradiation predispose to OS

- OS of jaws represent 6-8% of all OS

- Most common age of detection in jaws is 3rd/4th decades of life, with mean of 33 years - older than OS of long bones

- Males>females; maxilla=manidible, posterior most common

- Swelling, paint most common symptoms; loosening of teeth

- Can be radiolucent, radiopaque and everything in between

- Peripheral border generally ill-defined and indistinct; sometimes changes very subtle

- ~25% have "sunburst" appearance due to osteophyte formation on surface of bone (best demonstrated in occlusal film)

- Resorption of tooth roots in area in distinctive "spiking" pattern; symmetrical widening of PDL space of involved teeth

- Direct production of osteoid by malignant mesenchymal cells

- In addition a given tumor can produce other products as well, with the predominant product the basis for histologic classification (osteoblastic, chondroblastic, fibroblastic)

- But the sine qua non is malignant cells producing osteoid or bone

- Radical surgical excision, in some cases accompanied by either pre-surgical or post-surgical chemotherapy

- Prognosis very serious: can metastasize, most often to lung and brain; however most common cause of death in jaw lesions is uncontrolled local disease

- Survival rate varies with study but ranges from 30-70%

Peripheral (juxtacortical) osteosarcoma: parosteal, periosteal

Post-irradiation osteosarcoma

- Most commonly radiolucency with poorly defined borderrs

- May contain varying degrees of radiopaque foci which can occasionally be extensive

- If cortex is penetrated may produce sunburst pattern and/or symmetrical widening of PDL space of teeth involved similar to osteosarcoma

- Occasionally simply multilocular radiolucency mimicking a benign process

- Outside the jaws, most patients over 50 y/o, with peak prevalence in 6th and 7th decades; no racial or gender predilection; most cases found in ileum, femur, humerus, H&N infrequent

- In H&N, most common in maxilla, less in mandibular body, ramus, nasal septum and sinuses; 1/3 of H&N CS arise in either laryngotracheal cartilage or in soft tissue; otherwise demographics similar to those outside jaws

- Most common presenting sign in jaws: painless mass or swelling, someimtes with loosening or separation of teeth; max tumors may cause nasal obstruction, congestion, epistaxis, photophobia or visual loss

- composed of cartilage demonstrating varying degrees of maturation and cellularity, most often w/ lobular pattern

- Tumors are divided into Grades I, II, III. The more the tissue resembles normal cartilage, the lower the grade (I); the less the resemblance the higher the grade (III).

- Most chondrosarcomas of jaws are grades I and II

Variants: clear cell CS, dedifferentiated CS, myxoid CS, mesenchymal CS

Radical surgical excision

Radiation and chemo reserved for unresectable high grade CS

- Depends on location (and thus resectability) and histologic grade

- In large series of H&N CS< only 12% had regional or distant metastases at time of dx w/ tendency for metastasis in higher-grade and sinonasal

- 5-10 year survival rates 87% and 70% respectively

- Exact survival rates differ in other large studies, but clear possibility for late recurrence and mets: must be followed

- compromises only 3-9% of all CS

- Most common in 2nd and 3rd decade of life (25-30% involve jaws; 25-33% arise in soft tissues instead of bone)

- swelling and pain, often of short duration, most common symptom

- Radiograph: infiltrative radiolucency sometimes w/ stippled calcification

- Wide surgical excision is treatment of choice

- Local recurrence and metastasis (bloodborne) common and may be discovered as long as 20 years after initial therapy

- 10-year survival rate: 28%

- Peak age incidence 2nd decade of life most before 20 y/o

- Vast majority in caucasian patients; mand>maxilla

- Pain, swelling, fever, leukocytosis (mimicking infection)

- Commonly perforates cortical plate

- Paresthesia and loosening of teeth common

- Lytic bone destruction with ill-defined margins

- May be cortical destruction or expansion

- May be "onionskin" periosteal reaction (common in long bones) but rare in jaws

- Small round cells with well-demarcated nuclear outlines and ill-defined cellular borders arranged in broad sheets without any distinct patterns

- Large areas of necrosis and hemorrhage are common

- Definitive diagnosis usually requires series of specific immunohistochemical studies in addition to routine hematoxylin and eosin staining

- Combined surgery, radiation therapy and chemotherapy have improved prognosis significantly from previous 5% 5-year survival rate to 40-80%

- Although some clinicians reserve radiation therapy for those cases in which wide surgical excision is not possible (danger of post-irradiation OS)

Most common form of cancer involving bone in general

Can occur from breast, lung, thyroid, prostate, and kidney

- Patients most commonly older; mandible>maxilla

- Symptoms depend on location of metastasis (pain, parasthesia, swelling, loosening of teeth)

- Radiographic features vary widely - may mimic other more common jaw processes

- Prognosis is poor