OSTEOSARCOMA OF THE JAWS DURING PREGNANCY: CASE REPORT AND REVIEW OF THE LITERATURE

Abstract

Osteosarcoma of jaw bones represents less than 1% of all head and neck malignancies. Malignancy in pregnant women is also an uncommon event, and occurs in a ratio of one case per 1000 deliveries. The aim of this study is to report a rare case of maxillary osteosarcoma in a pregnant woman, and to review the previous cases published in English literature. A 29-year old woman, in the 33rd week of gestation, presented with a 2.5 cm reddish, multilobulated and ulcerated nodule in posterior maxilla with 1 month of evolution. Computerized tomography showed an expansive tumor destroying the alveolar bone around the molars and invading the maxillary sinus. The material of the first incisional biopsy was not enough to conclude the diagnosis. Before a second biopsy was done, the patient delivered normally a healthy boy. Histologically, the tumor was composed by round cells with prominent cytoplasm and pleomorphic nuclei, sometimes multinucleated. Areas with spindle and epithelioid cells were also found, among osteoid or chondroid matrix. The lesion was extremely vascularized, with mixomatous and telangiectatic regions. The final diagnosis was conventional osteosarcoma, and the lesion was surgically removed, with clear margins. A microsurgical flap was used for reconstruction and the patient received adjuvant radiation and chemotherapy. She has been followed up for one year, with no signs of metastasis or recurrence. The influence of pregnancy on the initiation, promotion and development of sarcomas is not well established. To the best of our knowledge, no more than 10 cases of jaw osteosarcoma in pregnant women have been reported up to now. The co-existence of malignancy and pregnancy is very uncommon, and sometimes a challenge for medical professionals, especially regarding the diagnosis, the use of ancillary examinations and the treatment.