Chondrosarcoma of the maxilla: A case report and review of literature
A 29-year-old male patient was referred to our department for evaluation and treatment of a swelling in the left anterior maxillary region. The patient complained of a slow growing swelling over the left cheek which had increased over a period of 1 year. The patient had noticed an intraoral swelling 25-30 days back for which he had consulted his dentist. He also noted teeth displacement over a period of 1 year. The patient denied any history of trauma and was asymptomatic.\nThe patient's medical and family history was unremarkable. He had the habit of chewing tobacco and areca nut since 5 years. Clinical examination revealed a diffuse swelling on the left side of the face extending from the ala of the nose up to the zygomatic region measuring approximately 3 × 3 cm. On palpation, the swelling was hard with defined borders. The overlying and adjacent skin was normal; no regional lymphadenopathy was noted.\nOn intraoral examination, an irregular lobulated swelling was noted involving the entire left side of the palate, which had crossed the midline []. Labially the swelling extended from 21 to 24 with obliteration of the labial vestibule; the teeth in this region were displaced with mobility in relation to 21 and 22. The consistency was firm to hard and the mucosa was intact.\nWater's view showed a well-corticated radiolucent lesion destroying the inferior border of the maxillary sinus on the left side. A mixed lesion was seen in 22 and 23 region in continuity with the above mentioned lesion. Intraoral periapical radiographs showed displaced teeth i.r.t 21, 22, and 23. Computed tomography (CT) imaging showed an irregular soft tissue mass causing osteolytic destruction of left upper maxillary alveolus, floor and lateral wall of left maxillary sinus, medial wall of right maxillary sinus, and posteromedial part of right orbit [].\nThe differential diagnosis included odontogenic tumors since lesions like adenomatoid odontogenic tumor are common in this location and present a mixed appearance radiographically and therefore was considered. The clinical features such as displacement and mobility of teeth and the radiographic extent of the lesion suggested that it may be a non-odontogenic tumor of the bone.\nFine needle aspiration biopsy smears showed a matrix dominated lesion with moderate cellularity. The matrix was chondromyxoid in nature. Cells either single or in groups were embedded in the matrix. The cells showed abundant to moderate amounts of well-defined cytoplasm. The cytoplasm was eosinophilic and vacuolated. Binucleation and trinucleation was seen. Moderate degree of nuclear pleomorphism was noted. Some cells showed large nuclei with increased nuclear cytoplasmic ratio. Cartilage with cells in lacunae were not seen []. In view of the clinical and radiological data, a diagnosis favoring well-differentiated chondrosarcoma was offered. Following this, an incisional biopsy was carried out.