Osteosarcoma of the mandible: A case report with an early radiographic manifestation
A 40-year-old female reported with the chief complaint of swelling in the right side of the lower jaw for the previous 10 days. The patient's medical and dental history was unremarkable, and the patient did not seem to have any harmful habits.\nOn extraoral examination, there was a swelling in the right mandible with a normal color and texture of the overlying skin. Mouth opening was found to be normal. Paraesthesia was detected in the skin over the swelling. The right submandibular lymph node was of 2 cm in size, palpable, tender, and non-fixed.\nIntraoral examination revealed a nodular swelling in the right mandible extending from the mandibular canine to the mandibular first molar. It measured approximately 3 cm×5 cm. The overlying mucosa was eyrthematous in appearance and the borders were well defined, with a consistency varying from firm to hard. Tenderness was present on palpation. The teeth near the swelling were not mobile ().\nA panoramic radiograph revealed a periradicular widening of the periodontal ligament space and loss of lamina dura involving the right mandibular second premolar and the mesial and distal roots of the first molar with mild rarefaction of the inter-dental alveolar bone between the roots of the mandibular right first molar and second molar ().\nAn intraoral periapical radiograph revealed a loss of the lamina dura and periradicular bone loss involving the interdental bone between the mandibular right second premolar and first molar (). A shadow of the soft tissue mass on the right side and mild peripheral cortical bone reactive bone formation in the molar and premolar region were visible in the right mandibular lateral occlusal radiograph (). Correlating the clinical and radiographic features, a provisional diagnosis of osteosarcoma involving the jaw bone was made.\nIncisional biopsy of the lesion was performed, and the hematoxylin-eosin stained section showed highly cellular connective tissue stroma, predominantly composed of neoplastic spindle cells that exhibited pleomorphism and hyperchromatism. Abundant neoplastic osteoid formation with varying degrees of calcification was seen within the stroma. The neoplastic bone showed typical peripheral rim of malignant osteoblasts as well as entrapped pleomorphic, hyperchromatic cells. Mitotic figures were also seen in the stroma (). A histopathological diagnosis of osteosarcoma was made.\nBased on the report, segmental resection of the right body of the mandible was performed with wide surgical resection margins. The resected tumor specimen also exhibited similar histopathological findings consistent with the incisional biopsy report of osteosarcoma.