Gnathic (Mandibular) Osteosarcoma in a Middle Adolescent - A case presentation and Review of the literature

Female, 17

Gnathic (Mandibular) Osteosarcoma

A 17-year-old-female presented with painful swelling and numbness on the inner aspect of the left hemimandible for 45 days. Previous dental history was unremarkable.

CT Mandible with Three-Dimensional (3D) Volume Rendered (VR) shows a focal mixed osteolytic-sclerotic lesion in the body and alveolar process of left hemimandible (in the region of canine and premolars teeth) with ill-defined margins of a wide zone of transition, cortical breach (inner cortex), spiculated periosteal reaction of “sun-burst/sun-ray appearance” associated with intra-oral soft tissue component on the lingual side of left hemimandible of size ~ 28 x 12 x 13 mm (anteroposterior x transverse x craniocaudal). MRI Mandible shows heterogeneous hypointensity-hyperintensity on STIR in the body, and alveolar process of left hemimandible (in the region of canine and premolars teeth) with ill-defined margins associated with intra-oral soft tissue component on the lingual side of left hemimandible and low (hypointensity) on ADC. HPE of the incisional biopsy of lingual 34, 35, 36 region shows connective tissue stroma contains collagen interspersed with plump and pleomorphic spindle cells with irregular hyperchromatic nuclei. Irregular eosinophilic lace-like malignant osteoid between stromal cells.