J Korean Assoc Oral Maxillofac Surg.  2017 Apr;43(2):120-124. 10.5125/jkaoms.2017.43.2.120.

A rare case of osteonecrosis of the jaw related to imatinib

• Viviano M
• Rossi M
• Cocca S

• KMID: 2377016
• DOI: http://doi.org/10.5125/jkaoms.2017.43.2.120

Abstract

Osteonecrosis of the jaw (ONJ) is commonly described as an adverse effect of the use of bisphosphonates. A few cases of ONJ associated with tyrosine kinase inhibitors (sunitinib, imatinib) have been reported in the literature and usually they occurred in patients simultaneously treated with bisphosphonates. We report an atypical case of ONJ related only to imatinib. A 72-year-old male patient was treated with imatinib for metastases from gastrointestinal stromal tumors (GISTs). The patient developed ONJ after 22 months of imatinib only therapy. During his whole life, the patient had never been treated with bisphosphonates or radiotherapy. Microscope examination of the tissues confirmed the clinical diagnosis of diffuse osteonecrosis and showed absence of neoplastic cells. Thus, secondary localisations from GISTs were ruled out. Osteonecrosis of the lower jaw appeared 22 months after initial and exclusive therapy with imatinib. Therefore, imatinib monotherapy can induce ONJ in patients that have never been treated with bisphosphonates or radiotherapy.

Keyword

Imatinib mesylate; Osteonecrosis; Oral surgery; Gastrointestinal stromal tumors; Bone remodeling

MeSH Terms

Aged
Bone Remodeling
Diagnosis
Diphosphonates
Gastrointestinal Stromal Tumors
Humans
Imatinib Mesylate*
Jaw*
Male
Neoplasm Metastasis
Osteonecrosis*
Protein-Tyrosine Kinases
Radiotherapy
Surgery, Oral
Diphosphonates
Imatinib Mesylate
Protein-Tyrosine Kinases

Figure

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  Fig. 1 First evaluation of the patient suffering by gastrointestinal stromal tumors and treated for 22 months with imatinib. A. Oral examination showed exposed bone in the right retromolar triangle, halitosis, sialorrhea, and anaesthesia. B. A black line restricts the region affected by anaesthesia.

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  Fig. 2 Radiologic images compare the situation before and after extraction of tooth (#47) during imatinib therapy. A. Panoramic radiograph before extraction of tooth (#47). B. Panoramic radiograph after extraction showing bone sequestration and osteonecrosis in the mandibular right retromolar triangle.

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  Fig. 3 Three-dimensional cone-beam computed tomography reconstruction of the jaw during imatinib therapy. A. Vestibular view of the jaw shows the perforation of mandibular bone cortex in the patient treated only with imatinib for 22 months. B. Lingual view of the jaw shows the destruction of normal anatomy and erosion of the mandibular canal.

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  Fig. 4 Histologic examination of the tissues confirmed the clinical diagnosis of diffuse osteonecrosis of the jaw. A. Histologic section of bone fragment showing diffuse osteonecrosis (H&E staining, ×25). Given the absence of neoplastic cells, secondary localisations from gastrointestinal stromal tumors were excluded. B. Histologic section of gingival fragment showing chronic purulent exudative inflammation, granulation tissue and acanthosis of the superficial layer (H&E staining, ×50).

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