title: Bisphosphonate-Related Osteonecrosis and Metastasis Within the Same Site of the Jaw.
abstract: Osteonecrosis of the jaw (ONJ) is a well known complication in patients treated with bisphosphonates (BPs) for skeletal metastasis and multiple myeloma (MM). Few oncologic patients under treatment with BPs and with ONJ and metastasis or MM at the same site of the jaw have been described. We report here on a 54-year old white female who was treated with intra-venous zoledronic acid for skeletal metastasis of breast cancer who developed ONJ. Because of a fracture at the site of ONJ, resection of the affected segment was performed. Although metastasis was not suspected by pre-operative image analysis, histological examination revealed syncronous osteonecrosis and breast cancer metastasis in the resected mandibular segment. This case highlights that, in oncologic patients treated with BPs, ONJ may hide malignancy and that histology is the unique tool by which the diagnosis of either osteonecrosis or malignancy or both can be made definitely.
authors.affiliation: Professor of Pathology, Department of Molecular Medicine, Sapienza University, Rome, Italy. Electronic address: alessandro.corsi@uniroma1.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Corsi
authors.affiliation: Maxillofacial Surgeon, Department of Odontostomatologic Sciences, Section of Maxillofacial Surgery, Sapienza University, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ungari
authors.affiliation: Professor of Pathology, Department of Molecular Medicine, Sapienza University, Rome, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Riminucci
authors.affiliation: Maxillofacial Surgeon, Department of Odontostomatologic Sciences, Section of Maxillofacial Surgery, Sapienza University, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Agrillo
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000175:diagnosis* / Q000473:pathology*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D003937:Diagnosis, Differential; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D005598:Fractures, Spontaneous / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects* / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008334:Mandible / Q000473:pathology; D008339:Mandibular Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000473:pathology*; D011862:Radiography, Panoramic; D014057:Tomography, X-Ray Computed; D000077211:Zoledronic Acid
chemical_list: D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid