title: Malignancy mimicking bisphosphonate-associated osteonecrosis of the jaw: a case series and literature review.
abstract: OBJECTIVE
  Bisphosphonate-related osteonecrosis of the jaw (BONJ) is a common complication of bisphosphonate treatment that has been well documented over the past decade. Nevertheless, its pathogenesis is poorly understood, and treatment guidelines are based mostly on expert recommendations. Clinicians must be aware of malignancy mimicking BONJ, of which a few cases have been documented in the literature.
  
  
  METHODS
  Three patients undergoing long-term treatment with intravenous bisphosphonates for malignant disease demonstrated the distinct diagnostic signs of BONJ. Surgical treatment was performed by resecting the affected bone. In all cases, histologic specimens were taken for analysis.
  
  
  RESULTS
  Histologic analysis of the bone specimen with surrounding soft tissue revealed necrotic bone with signs of inflammation, but also with cells of the underlying malignant disease.
  
  
  CONCLUSIONS
  Clinical and radiographic diagnosis of BONJ should be confirmed by histologic analysis in patients with underlying malignant disease.
authors: Department of Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland. Electronic address: Thomas.Gander@usz.ch.
authors: Thomas
authors: T
authors: Gander
authors: Department of Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland.
authors: Joachim A
authors: JA
authors: Obwegeser
authors: Department of Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland.
authors: Wolfgang
authors: W
authors: Zemann
authors: Department of Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland.
authors: Klaus-Wilhelm
authors: KW
authors: Grätz
authors: Department of Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland.
authors: Christine
authors: C
authors: Jacobsen
mesh_terms: D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000175:diagnosis*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary*; D003937:Diagnosis, Differential; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007573:Jaw Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis*; D012189:Retrospective Studies
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates