CASE PRESENTATION

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.
 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.

 Reddish lining Bleeding on touch,
Volume increase mucosa with in the left posterior
ulcerated areas mandibular region
 PROVISIONAL DIAGNOSIS
• Osteosarcoma
• Osteomyelitis
 CLINICAL DD
 MFH

 Fibrosarcoma
 Ewing’s sarcoma

 Lymphoma
 Chondrosarcoma

 Giant cell tumor of bone

 Metastasis

 Langerhans cell histiocytosis

 Fibrous dysplasia

 ABC
 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.

 FINAL DIAGNOSIS
• Chondroblastic variant of Osteosarcoma
 HISTO DD

• Chondroma

• Chondroblastoma

• Chondrosarcoma

• HG sarcoma NOS

• Metaplastic carcinoma from breast

• Pleomorphic sarcoma with chondroid variant

 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.
THANK YOU!