2. CHIEF COMPLAINT
A 32-year-old male pt – swelling
– left side – 3 months
H/O volume increase in the
middle and lower third of left
side face – since 3 months
No systemic diseases.
vital signs - adequate for his age.
No paresthesia, episodes of
infections.
3. CLINICAL FINDINGS
Noticeable increase in volume
Middle and lower third of the left side of the face
4*4 cm in size
Facial asymmetry
Hard consistency on palpation.
8. GROSS EXAMINATION
• Excised biopsy specimen -lobulated mass - 9x7 cm - firm in consistency -
reddish pink in colour.
• The cut surface - grayish white in colour - glistening appearance.
21. HISTO DD
• Chondroma
• Chondroblastoma
• Chondrosarcoma
• HG sarcoma NOS
• Metaplastic carcinoma from breast
• Pleomorphic sarcoma with chondroid variant
22. DISCUSSION
• Chondroblastic osteosarcoma in an ossifying fibroma site in maxilla.
• Dodd et al noted a sensitivity of 65% for a conclusive diagnosis of
osteosarcoma using FNA as the sole pathologic diagnostic technique.
• New treatment modalities - expression of inducible nitric oxide synthase
(iNOS) - may promote tumour angiogenesis in OS of the jaw and may present
an important target in anti-tumour therapy.
• Fluoride level in the neoplastic tissue of Osteosarcomas and the osteoblastic
variants of this malignant tumor are significantly higher - from regions where
the fluoride level in drinking water is higher than - recommended by WHO ,
fluoride ions has a mitogenic effect on malignant osteoblasts.
Editor's Notes
in a panoramic reconstruction, the presence of a mixed image with poorly defined limits, located in the posterior mandible area, on the left side. Furthermore, partial resorption of the distal root of tooth 37 was observed.
In coronal sections, it was possible to observe perforation of buccal and lingual cortical plate and osteophytic reaction.
In the axial sections, change was observed in the density of the trabecular bone, which was hyperdense.
Therefore, the clinical and imaging examination were osteosarcoma and osteomyelitis.
