Osteosarcoma of mandible: Detailed radiographic assessment of a case
A 28-year-old male patient reported to Dental Department of a Private Hospital with the chief complaint of rapidly increasing swelling at left body of mandible []. Patient had visited an oral and maxillofacial clinic for tenderness at same site, and extraction of 38 was performed. After extraction, patient noticed fast progression of swelling with no relief in pain. Swelling was bony hard. Submandibular lymph nodes of involved side were palpable and non-tender. Intraoral examination revealed obliteration of buccal vestibule in relation to 35, 36 and 37. Intraoral radiograph, in early stage of disease, revealed widening of periodontal ligament (PdL) space in relation to 35, 36 and 37 without any evidence of odontogenic or periodontal disease.\nRadiographic imaging using CT, 3-D CT and CT angiography techniques were performed. CT scan revealed a large tumor mass originating from surface of outer cortex of body and angle of mandible []. Lesion extended from first molar to posterior border of ramus anterio-posteriorly. Tumor involved coronoid process above and extended 1.5 cm below lower border of mandible. Lower border of mandible was seen destroyed and replaced by connective tissue stroma of tumor. A mixed radiopaque and radiolucent mass with typical “sunburst” appearance at outer cortex with “codman's triangle” at the margins of tumor led to the diagnosis of OS []. 3D CT images revealed extensive spread of tumor mass. Tumor osteoid was seen forming a complex network radiating from body and angle of mandible and reaching coronoid notch []. Study of bone destruction pattern on CT scans revealed a predominant bone-destruction negative pattern. At most areas of tumor involvement the continuity of outer cortical plate is intact, with tumor osteoid radiating outwards. However, at lower border of mandible tumor mass is seen destroying entire thickness of bone and replacing with radioluscent soft-tissue mass. CT angiography was performed to assess the vascularity of tumor. The tumor was found to be extensively vascularized and the feeder vessel was identified to be external carotid artery []. Incisional biopsy showed osteoid areas lined by plump osteoblasts with hyperchromatic nuclei, mitotic figures, and sheets of cells showing nuclear and cellular pleomorphism, inflammatory cells, numerous blood vessels and hemorrhage []. Case was operated upon under general anesthesia, tumor mass resection with reconstruction using iliac crest was done []. Final diagnosis was consistent with that of representative specimen.