Osteosarcoma with Tongue Metastasis: a Rare Case Report
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CASE REPORT
Osteosarcoma with Tongue Metastasis: a Rare Case Report Harish Verma 1
&
Bharat Bhushan Bassan 1 & Reetesh Ranjan 1 & Surender Kumar Dabas 1
Received: 5 May 2020 / Accepted: 15 September 2020 # Indian Association of Surgical Oncology 2020
Introduction Osteosarcoma is a primary intramedullary high-grade malignant tumor of bone, in which the neoplastic cells produce osteoid [1]. Osteosarcoma is the most common primary malignant tumor of bones, accounting for 40–60% of all malignant bone tumors [2]. Osteosarcoma of the maxillofacial region (primary or metastatic) is rare [3], which accounts for approximately 5% [1]. The mandible is more commonly involved than maxilla (1.5:1 to 2:1). Lung is the most common site of metastases from osteosarcoma followed by bone [4, 5]. There are various identified epidemiological risk factors related to development of osteosarcoma, which include history of ionizing radiation exposure, fibrous dysplasia, bone cysts, osteogenesis imperfecta, osteochondroma, trauma, hereditary retinoblastoma, or prior exposure to thorium oxide [6]. Mutation in tumor suppressor gene like p53 and retinoblastoma gene (Rb) is more likely to cause this tumor [7]. Metastases to the oral cavity and jaw bone are rare, which account for less than 1% [8]. And extensive literature review has revealed only few well-documented cases of metastatic osteosarcoma to the oral cavity [8].
Case Report A 26-year-old male patient already a diagnosed case of osteosarcoma of the left femur presented with lesion over the anterior tongue. He was diagnosed with osteosarcoma of left femur in August 2017, and after 3 cycles of NACT, he underwent limb salvage surgery followed by adjuvant chemotherapy. He developed metastasis to right upper lobe of lung (Fig. 1) and underwent thoracoscopic metastasectomy. One * Harish Verma [email protected] 1
Department of Surgical Oncology, BLK Superspeciality Hospital, Delhi, India
year later, he presented again to our department with complaints of difficulty in swallowing and lesion over the anterior tongue. Clinical examination showed a pedunculated and proliferative mass arising from the left lateral border of the anterior tongue (Fig. 2). The rest of the clinical examination was unremarkable. Whole body PET-CT showed localized disease. An incisional biopsy from the lesion was suggestive of sarcoma. Wide local excision (Fig. 3) of the tongue lesion was done and defect was closed primarily. Histopathology report was consistent with osteosarcoma. Post-operative period was uneventful and healing was satisfactory (Fig. 4).
Discussion This report has described a case of metastasis to the tongue that developed more than 2 years after surgical resection of the osteosarcoma of the lower extremity. Metastatic tumors of the oral cavity are less common than primary lesions. In about 33% of patients, oral secondary tumors are the initial indicators of the presence of the primary tumors. Ninety percent of all oral metastatic tumors occur in the jaws, of which 72% occur in the mandib
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