Domestic Animals–Brief Communication

Veterinary Pathology
2019, Vol. 56(2) 274-276
Zygomatic Arch Parosteal Osteosarcoma ª The Author(s) 2018
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in Dogs and a Cat DOI: 10.1177/0300985818798110
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Randi Gold1 , Fabiano Oliveira2, and Roy Pool1

Abstract
Parosteal osteosarcoma is a rare, slow-growing tumor most commonly arising from the surface of long bones. Tissue or his-
tological sections from 5 dogs and 1 cat with zygomatic arch masses were examined. Clinical presentations varied from chronic
sneezing to facial swelling. Imaging consistently demonstrated osseous proliferation in the area of the zygomatic arch. Histolo-
gically, the masses were characterized by well-differentiated fibro-osseous and chondroid components that radiated outward
from the periosteum of the zygomatic bone. Cellular atypia and mitotic figures were uncommon. Parosteal osteosarcomas have
previously been reported in the skulls of dogs and cats, but only 1 has been reported on the zygomatic arch. Initially, these tumors
are of low histologic low grade, but with time, they can show more aggressive behavior and invade the underlying bone.

Keywords
zygomatic arch, osteosarcoma, parosteal, neoplasia, maxilla, dog, cat

Osteosarcomas are a common malignant tumor in veterinary
medicine, accounting for up to 85% of the malignant bone tumors
in dogs and approximately 70% in cats.16 Most osteosarcomas
arise within bones, particularly at the metaphyseal region of long
bones, and are referred to as central osteosarcoma.3 A second and
much less common type of osteosarcoma originates on the sur-
face of bones, arising from either the osteogenic or fibrous layer
of the periosteum,3 and is referred to as peripheral osteosarcoma.
This second group is subcategorized into periosteal osteosar-
coma, which may show malignant biological behavior similar
to central osteosarcoma, and parosteal osteosarcoma, which is
slow growing and less prone to distant metastasis and carries an
overall more favorable prognosis than central osteosarcoma.1,3,11
In humans, the difference in biological activity is emphasized by
the 80% 5-year survival time for parosteal osteosarcoma com-
pared to 15% for intraosseous osteosarcoma.19
Periosteal osteosarcoma originates from the undifferentiated
cells of the periosteal osteogenic layer and will cause bony
lysis, neoplastic bone formation, secondary reactive bone for-
mation, and invasion into the medullary cavity.3,11 Parosteal
osteosarcoma originates from the fibrous layer of the perios-
teum.16 Grossly, they are firm to hard masses with a smooth
exterior connected to the surface of the cortex by a sessile or
pedunculated base from which they grow outward.16 Typically,
they are well differentiated with irregularly fragmented oss-
eous trabeculae present within a neoplastic spindle-cell stroma
that runs in random directions. The cellularity of the spindle
cells can vary, but they generally lack pleomorphism and have
a low mitotic index and low metastatic potential.3,13,18 The
underlying cortex is generally intact; however, given enough
time, they can transform to a more aggressive population with
pleomorphism, cellular atypia, and extension into the cortex
and medullary canal with metastasis as documented in both the
veterinary and human literature.3,10,11,14,16,18 The histologic
appearance is key to differentiating these tumors from others
that can also form on the surface of the skull and may have a
similar gross appearance. An example is the multilobular tumor
of bone, which has a characteristic pattern consisting of mul-
tiple circular, oval, or irregularly shaped nodules or islands of
cartilaginous, osseous, or osteocartilagenous tissue separated
by narrow anastomosing fibrous septae.3 The fibrous septa
create a lobulated pattern in the latter in contrast to the paros-
teal osteosarcoma, which has a more haphazard stromal align-
ment without forming discrete nodules. Another example is
fibrous dysplasia, which is composed of well-differentiated
fibrous tissue containing trabeculae of woven bone that are
relatively regularly spaced and sized and lack osteoblasts on
the trabecular surface.11 The orderly arrangement is key for
distinguishing it from a parosteal osteosarcoma. The trabeculae
of a parosteal osteosarcoma are often covered by spindle cells;
however, they can contain a single layer of osteoblasts,18 as
1
Department of Veterinary Pathobiology, College of Veterinary Medicine and
Biomedical Sciences, Texas A&M University, College Station, TX, USA
2
Antech Diagnostics, College Station, TX, USA
Corresponding Author:
Randi Gold, Department of Veterinary Pathobiology, College of Veterinary
Medicine Texas A&M University, 4467 TAMU, College Station, TX 77843,
USA.
Email: rgold@cvm.tamu.edu
Gold et al 275

Table 1. Signalment, Clinical Presentation, and Anatomic Location of Parosteal Osteosarcoma in 5 Dogs and 1 Cat.

ID Breed Sex Age (y) Presentation Side, Zygomatic Arch Border

1 Shetland Sheepdog M, C 8 Chronic sneezing Left, axial border

2 Boston Terrier M, C 11 Left facial swelling Left, rostral border
3 Golden Retriever U, U 10 U Left, unknown
4 Domestic Short Hair Cat F, S 14 U Right, unknown
5 Labrador Retriever F, S 11 Left facial mass Left, dorsal border
6 Boston Terrier F, U 10 Right facial swelling Right, rostral border
Abbreviations: C, castrated; F, female; M, male; S, spayed; U, unknown.

Figures 1–4. Parosteal osteosarcoma, zygomatic arch, dog. Figure 1. Case 2. Computed tomography transverse plane through the skull
showing moderate osseous proliferation with minimal invasion of the zygomatic arch. Figure 2. Case 2. The neoplasm is arising from the fibrous
periosteum and is composed of a neoplastic, highly cellular, fibrous layer admixed with few haphazardly oriented trabeculae of woven bone. The
neoplastic cells have invaded into the osteogenic layer and initial cortical compacta. HE. Figure 3. Case 1. Neoplastic cells are arranged in
moderately cellular bundles with intervening broad trabeculae of well-differentiated neoplastic woven bone. HE. Figure 4. Case 1. Neoplastic
cells have angular profiles and are entrapped within an osteoid matrix. Mitotic figures are not apparent. HE.

opposed to the trabeculae in fibrous dysplasia. First character-
ized in humans by Geschickter and Copeland5 in 1951 as a
“parosteal osteoma,” parosteal osteosarcoma has since been
recognized in animals, but published reports are
rare.2,8,9,12,15,17,19,20 This report documents 6 cases of parosteal
osteosarcoma of the zygomatic arch in 5 dogs and 1 cat.
All cases were evaluated by the Osteopathology Service at the
Texas A&M Veterinary Medical Teaching Hospital as outpatient
sample submissions. The availability of historical and diagnostic
imaging findings for certain cases was limited. Signalment and
clinical information are listed in Table 1. Overall, the animals
ranged from 8 to 14 years old with a mean age of 11; no breed or
sex predilection was noted. The gross appearance in these cases
consisted of contoured, sessile, osseous proliferations on the zygo-
matic arch, which corresponded to radiograph (2/6 cases) or com-
puted tomography imaging findings (4/6 cases; Fig. 1). All cases
shared similar features. The masses were centered on and appeared
to arise from the surface of the zygomatic bone (Fig. 2). In most of
these lesions, tumor cells had begun to invade the osteogenic layer
and surface of the cortical compacta, similarly to documented cases
of human parosteal osteosarcoma (Fig. 2).10,14,18 The neoplasms
were comprised of haphazardly arranged anastomotic trabecular
systems of woven bone separated by a moderately cellular fibro-
vascular network (Figs. 3, 4). Neoplastic cells were spindle to
polygonal with angular profiles and often entrapped within their
fibrillar matrix (osteoid) (Fig. 4). Mitotic figures were not apparent.
Multifocally were solid sheets of neoplastic fibro-osseous tissue
having no distinctive pattern. A cartilage cap over the external
surface was absent in these masses.
Human parosteal osteosarcoma is largely confined to long
bones,1,4,6,9,13 but animal cases can occur in the skull.8,9 Other pub-
lished locations have included the cervical vertebrae in the dog,15
scapula in the cat,12 and appendicular skeleton in the dog2 and the
cat.17,20 Bones of the skull differ from the long bones of the appen-
dicular skeleton both in their embryology and resulting histological
appearance. Flat bones of the skull are formed by intramembranous
ossification while the long bones are formed by endochondral ossi-
fication.7 The cases presented here were all confined to the zygo-
matic arch. To the authors’ knowledge, only a single parosteal
osteosarcoma of the zygomatic arch has been reported.19
The use of en bloc resection has only rarely been used for
the treatment of intraosseous osteosarcoma because of late rec-
ognition of the tumor, local destruction, rates of metastasis, and
lack of normal bone after resection.19 However, parosteal
osteosarcoma of the zygomatic arch is well suited for this tech-
nique due to the low grade of malignancy and ease of accessi-
bility. In the aforementioned case report, early diagnosis
followed by complete resection resulted in a cure.19 In this case
series, 1 of the biopsy specimens was from an animal present-
ing for regrowth of a previous zygomatic arch osteoma that was
276
removed almost 2 years prior (case 4). It is possible the original
mass was actually a parosteal osteosarcoma. This demonstrates
that even if complete excision does not occur, slow growth of
the mass and benign biological activity still allow for a suc-
cessful outcome with extension of life.
Parosteal osteosarcoma is a slow-growing neoplasm that
manifests as an osseous mass expanding the periosteum and
generally sparing the medullary cavity. Many of the cases pre-
sented here had cortical invasion, demonstrating the chronicity
of the lesions despite an otherwise benign histologic appear-
ance. In humans, parosteal osteosarcoma is found primarily in
the distal femur, followed by the proximal tibia and proximal
humerus.6 Animals appear unique in that the skull is also a
preferred location. Interestingly, all 6 cases presented here
were confined to the zygomatic arch. The reason is unknown,
but given the predilection for domestic species to spend long
period of time chewing, it may be a functional predisposition
whereby localized repeat trauma increases cell turnover and
induces cell mutagenesis, warranting further study. The prog-
nosis of paraosteal osteosarcoma is more favorable than central
osteosarcoma, as evident by slow growth and a decreased like-
lihood of metastasis.2,8,19 As such, surgical intervention may be
warranted and successful if early in the clinical course.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
ORCID iD
Randi Gold https://orcid.org/0000-0003-1226-7282
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