Oral metastasis of chondroblastic osteosarcoma
A 24-year-old male patient attended the OPD of our college with a chief complaint of swelling in lower right back tooth region since 2 months. The swelling was non-tender and initially peanut size, which gradually increased to present size.\nPast medical history revealed that the patient was treated for osteosarcoma of 4th rib 4 years back at a Regional Cancer Institute []. Neoadjuvant chemotherapy (Cysplastin and Adriamycin) for about 2 months followed by palliative radiotherapy for 33 days were also administered. After that, the patient was asymptomatic until a swelling developed in his lower jaw.\nOn extra-oral examination, a diffuse swelling was seen on the right side of the face, measuring approximately 1.5 × 2 cm extending superiorly 1 cm below the level of outer canthus of the eye and inferiorly 1 cm above the lower border of the mandible, anteriorly from the corner of the mouth to 1 cm in front of the tragus of ear [].\nBilateral, sub-mandibular lymph nodes were palpable, which were non-tender, mobile, firm, round to ovoid in shape, measuring approximately 1 × 1 cm.\nGeneral physical examination revealed a solitary large nodular swelling on the left side of 4th rib region, measuring approximately 10 × 8 cm, which was well-circumscribed, non-tender, firm, oval in shape. Intra-oral examination revealed two well-defined pedunculated masses of approximately 3 × 2 cm arising from right buccal and lingual attached gingiva in relation to 44, 45, 46, and 47, causing obliteration of buccal and lingual vestibule. A solitary ulceration was present in the retromolar pad area covered by pseudo-membranous slough. The lesions were pink in color; smooth-surfaced with areas of indentation of teeth on superior surface, mild tender, and firm in consistency with indurated margins [].\nOrthopantamograph (OPG) revealed mild bone erosion in relation to 48 [].\nAn incisional biopsy was performed. Histologically, the tumor showed hyperplasic stratified squamous epithelium with rete ridge formation and connective tissue composed of neoplastic cells infiltrating the stroma, with cellular pleomorphism, hyperchromatism and with few mitotic figures. Focal areas of osteoid formation with chondroblastic differentiation were also present, which was suggestive of chondroblastic osteosarcoma [Figures and ].