title: Low-grade central osteosarcoma of the mandible: a case study report.
abstract: 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.
authors.affiliation: Department of Stomatology, School of Dentistry, Federal University of Goiás, Goiás, Brazil.
authors.forename: Ana Flávia N M S
authors.initials: AF
authors.lastname: Diniz
authors.forename: João Alves A
authors.initials: JA
authors.lastname: Filho
authors.forename: Rita de Cássia G
authors.initials: Rde C
authors.lastname: Alencar
authors.forename: Robson R
authors.initials: RR
authors.lastname: Garcia
authors.forename: Márcio R B
authors.initials: MR
authors.lastname: Silva
authors.forename: Rejane F
authors.initials: RF
authors.lastname: Ribeiro-Rotta
authors.forename: Maria A G S
authors.initials: MA
authors.lastname: Silva
authors.forename: Aline C
authors.initials: AC
authors.lastname: Batista
authors.forename: Elismauro Francisco
authors.initials: EF
authors.lastname: Mendonça
mesh_terms: D000328:Adult; D019926:Cyclin B / Q000096:biosynthesis; D056744:Cyclin B1; D003937:Diagnosis, Differential; D005260:Female; D005357:Fibrous Dysplasia of Bone / Q000175:diagnosis; D006801:Humans; D007124:Immunoenzyme Techniques; D019394:Ki-67 Antigen / Q000096:biosynthesis; D008339:Mandibular Neoplasms / Q000378:metabolism / Q000473:pathology*; D012516:Osteosarcoma / Q000378:metabolism / Q000473:pathology*; D018809:Proliferating Cell Nuclear Antigen / Q000096:biosynthesis
chemical_list: C534699:CCNB1 protein, human; D019926:Cyclin B; D056744:Cyclin B1; D019394:Ki-67 Antigen; D018809:Proliferating Cell Nuclear Antigen