SUNRAY APPEARANCE ON SONOGRAPHY IN OSTEOSARCOMA OF THE MANDIBLE: A RARE CASE REPORT

Abstract

Osteosarcoma comprises 23% of head and neck malignancies. Studies show that 6% to 9% of all osteosarcomas are seen in the maxilla and mandible. In osteosarcoma in jaws, the survival rate is higher and the risk of metastasis is lower compared to osteosarcoma in the extremities. The gold standard in osteosarcoma diagnosis is computed tomography and magnetic resonance imaging. ‘Sunray appearance’ is a common radiologic finding of sarcomas. A 29-year-old male patient received to our clinic with pain and swelling in the right mandible. Extra-oral examination revealed that facial asymmetry and significant swelling in the right mandible. On the cone beam computerized tomography examination, a lytic, mixed lesion area was observed with conical shaped root resorption around the mandibular right second premolar and first molar tooth roots. Ultrasound examination revealed that thinning, expansion, and erosion of the buccal cortical bone and 'sunray appearance' in the mandible. Cone beam computerized tomography and ultrasound have become an important diagnostic technique for the evaluation of maxillofacial pathologies. Ultrasound imaging is a rapid technique that aids in the early and differential diagnosis of pathologies. Sunray appearance is a pathognomic finding for osteosarcoma. In present case report, diagnostic ultrasonography is the second case in the literature used in osteosarcoma of the mandible. Keywords: Cone beam computed tomography, jaw osteosarcoma, sunray, ultrasonography MANDİBULA OSTEOSARKOMUNDA ULTRASONOGRAFİDE GÜNEŞ IŞINI GÖRÜNÜMÜ: NADİR BİR OLGU SUNUMU ÖZ Osteosarkom, baş ve boyun malignitelerinin % 23'ünü oluşturur. Çalışmalar, tüm osteosarkomların % 6 ila % 9'unun maksilla ve mandibulada görüldüğünü göstermektedir. Çenelerde görülen osteosarkomda sağkalım oranı daha yüksektir ve metastaz riski ekstremitelerde görülen osteosarkom ile karşılaştırıldığında daha düşüktür. Osteosarkom tanısında altın standart bilgisayarlı tomografi ve manyetik rezonans görüntülemedir. Radyografik olarak, “güneş ışını görünümü” sarkomların yaygın bir bulgusudur. 29 yaşında erkek hasta kliniğimize sağ mandibulada ağrı ve şişlik ile başvurdu. Ekstraoral muayenede, yüz asimetrisi ve sağ mandibular çenede belirgin şişlik gözlendi. Konik ışınlı bilgisayarlı tomografi incelemesinde, mandibular sağ ikinci premolar ve birinci molar diş kökleri çevresinde konik şekilli kök rezorpsiyonu ile litik, karışık bir lezyon alanı gözlenmiştir. Ultrasonografide ise, mandibulada bukkal korteksin kemik incelmesi, erozyonu ve “güneş ışını görünümü” gözlenmiştir. Konik ışınlı bilgisayarlı tomografi ve ultrasonografi, maksillofasiyal patolojilerin değerlendirilmesi için önemli bir tanı tekniği haline gelmiştir. Ultrasonografi, patolojilerin erken ve ayırıcı tanısına yardımcı olan hızlı bir tekniktir. Güneş ışını görünümü osteosarkom için patognomik bir bulgudur. Sunduğumuz olgu; mandibula osteosarkomunun tanısında ultrasonografi kullanılan literatürdeki ikinci olgudur. Anahtar Kelimeler: Çene osteosarkomu, güneş ışını, konik ışınlı bilgisayarlı tomografi, ultrasonografi

Keywords

• ultrasonography
• jaw osteosarcoma,
• Cone beam computed tomography,

SUNRAY APPEARANCE ON SONOGRAPHY IN OSTEOSARCOMA OF THE MANDIBLE: A RARE CASE REPORT

Abstract

Osteosarcoma comprises 23% of head and neck malignancies. Studies show that 6% to 9% of all osteosarcomas are seen in the maxilla and mandible. In osteosarcoma in jaws, the survival rate is higher and the risk of metastasis is lower compared to osteosarcoma in the extremities. The gold standard in osteosarcoma diagnosis is computed tomography and magnetic resonance imaging. ‘Sunray appearance’ is a common radiologic finding of sarcomas. A 29-year-old male patient received to our clinic with pain and swelling in the right mandible. Extra-oral examination revealed that facial asymmetry and significant swelling in the right mandible. On the cone beam computerized tomography examination, a lytic, mixed lesion area was observed with conical shaped root resorption around the mandibular right second premolar and first molar tooth roots. Ultrasound examination revealed that thinning, expansion, and erosion of the buccal cortical bone and 'sunray appearance' in the mandible. Cone beam computerized tomography and ultrasound have become an important diagnostic technique for the evaluation of maxillofacial pathologies. Ultrasound imaging is a rapid technique that aids in the early and differential diagnosis of pathologies. Sunray appearance is a pathognomic finding for osteosarcoma. In present case report, diagnostic ultrasonography is the second case in the literature used in osteosarcoma of the mandible. Keywords: Cone beam computed tomography, jaw osteosarcoma, sunray, ultrasonography

Keywords

• Cone beam computed tomography
• jaw osteosarcoma, sunray,

References

1. 1. Lin PP, Patel S. Osteosarcoma. In: Bone Sarcoma. Springer; 2013:75-97.
2. 2. Kocasaraç HD. Osteosarkom, Kondrosarkom, Ewing Sarkomu. Türkiye Klinikleri Ağız Diş ve Çene Radyolojisi-Özel Konular 2017;3:64-9.
3. 3. Garrington GE, Scofield HH, Cornyn J, Hooker SP. Osteosarcoma of the jaws. Analysis of 56 cases. Cancer 1967;20:377-91.
4. 4. Caron AS, Hajdu SI, Strong EW. Osteogenic sarcoma of the facial and cranial bones: A review of forty-three cases. Am J Surg 1971;122:719-25.
5. 5. Russ JE, Jesse RH. Management of osteosarcoma of the maxilla and mandible. Am J Surg 1980;140:572-6.
6. 6. Sanroman JF, del Hoyo JA, Diaz F, et al. Sarcomas of the head and neck. Br J Oral Maxillofac Surg 1992; 30:115-8.
7. 7. Slootweg PJ, Müller H. Osteosarcoma of the jaw bones Analysis of 18 cases. J maxillofac Surg 1985; 13:158-66.
8. 8. Nthumba PM. Osteosarcoma of the jaws: a review of literature and a case report on synchronous multicentric osteosarcomas. World J Surg Oncolog 2012; 10:240.

9. 9. Delgado R, Maafs E, Alfeiran A, et al. Osteosarcoma of the jaw. Head & neck. 1994;16(3):246-252.
10. 10. SÜMER AP, ÇALIŞKAN A. Çene Kemiklerinde İzlenen Osteosarkom. Türkiye Klinikleri Ağız Diş ve Çene Radyolojisi-Özel Konular 2015;1:10-6.
11. 11. Sengüven DB, Gültekin SE, Uluoğlu Ö. Çene Osteo- sarkomlarında Proliferasyon İndeksinin Değerlendiril- mesi. Atatürk Üniv Diş Hek Fak Derg 23:75-81.
12. 12. August M, Magennis P, Dewitt D. Osteogenic sarcoma of the jaws: factors influencing prognosis. Int J Oral Maxillof Surg 1997; 26:198-204.
13. 13. Mardinger O, Givol N, Talmi YP, Taicher S. Osteosarcoma of the jaw: the Chaim Sheba Medical Center experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:445-51.
14. 14. Ng SY, Songra A, Ali N, Carter JLB. Ultrasound features of osteosarcoma of the mandible—a first report. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 2001;92:582-6.
15. 15. Nissanka E, Amaratunge E, Tilakaratne W. Clinicopathological analysis of osteosarcoma of jaw bones. Oral Diseas 2007;13:82-7.
16. 16. White SC, Pharoah MJ. The evolution and application of dental maxillofacial imaging modalities. Dent Clin North Am 2008;52:689-705.
17. 17. Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Canadian Dent Assoc 2006;72:75.
18. 18. Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IB. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol 1998;8:1558-64.
19. 19. Akarslan Z, Peker İ. Bir diş hekimliği fakültesindeki konik ışınlı bilgisayarlı tomografi incelemesi istenme nedenleri. Acta Odont Turcica 2015;32:1-6.
20. 20. Yeung AWK, Tanaka R, Khong P-L, von Arx T, Bornstein MM. Frequency, location, and association with dental pathology of mucous retention cysts in the maxillary sinus. A radiographic study using cone beam computed tomography (CBCT). Clin Oral Inves 2018; 22:1175-83.
21. 21. Kocasarac HD, Angelopoulos C. Ultrasound in dentistry: toward a future of radiation-free imaging. Dent Clin 2018;62:481-9.
22. 22. Mittal A, Mehta V, Bagga P, Pawar I. Sunray appearance on sonography in Ewing sarcoma of the clavicle. J Ultrasound Med 2010; 29:493-5.
23. 23. Kleer CG, Unni KK, McLeod RA. Epithelioid heman- gioendothelioma of bone. Am J Surg Pathol 1996; 20: 1301-11.
24. 24. Forteza G, Colmenero B, Lopez-Barea F. Osteogenic sarcoma of the maxilla and mandible. Oral Surg Oral Med Oral Pathol 1986;62:179-84.
25. 25. Klaassen M, Hoffman G. Ewing sarcoma presenting as spondylolisthesis. Report of a case. JBJS 1987; 69:1089-92.
26. 26. Clark JL, Unni KK, Dahlin DC, Devine KD. Osteosarcoma of the jaw. Cancer. 1983;51: 2311-6.