Oral Pathology: Bone Case #8
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Patient: 15 year old girl
Persistent, progressive discomfort in the left jaw of six weeks duration. In the past week, the patient has had limitation of jaw opening and has become aware of swelling on the left side of her face.
Alert, normally developed, in no distress. Patient is in the second trimester of pregnancy. Denies cardiovascular, pulmonary, gastrointestinal, genitourinary, allergic disease or abnormality.
Except for the chief complaint, routine development and care.
Moderate facial asymmetry due to enlargement in the left preauricular-masseter region. Swelling is poorly delineated, firm and tender to palpation with fixation to deep structures but not to overlying skin. Maximum incisal edge opening 25 mm with limitation in lateral excursive movements of the mandible. The left ramus of the mandible demonstrates a diffuse radiopaque lesion. No other abnormalities are identified.
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Pain, and swelling of six weeks duration. Enlargement is firm and fixed to deep structures and is diffusely radiopaque radiographically.
Lesions to Include/Exclude:
Exclude cysts, benign odontogenic lesions, benign nonodontogenic lesions and other localized lesions because they are well-circumscribed.
Without historical or clinical evidence of inflammatory stimulus we may exclude inflammatory lesions.
Exclude primary lesions of bone because these involve more than one bone.
Exclude radiolucent malignancies.
Include malignant variable lesions in the differential diagnosis, especially osteosarcoma, chondrosarcoma and Ewings sarcoma. Metastatic carcinoma can be excluded because of the patient's age.
The histologic features of this lesion were those of osteosarcoma. This variable, diffuse lesion is the most common primary malignant tumor of bone. Swelling and pain are common symptoms and the lamina dura is often widened when the lesion occurs in the area of teeth.
Histologically, there may be osteoid, chondroid and or fibrous connective tissue laid down by uniform to very pleomorphic tumor cells.
Radical excision and chemotherapy or radiation treatment are used. Because of the diffuse margins and difficulty of including the entire lesion, recurrence rates may be as high as 70%.
Osteosarcomas of the jaws and especially the mandible have a better prognosis than other bones. However, the overall prognosis is serious and long-term followup is required. The prognosis has improved since chemotherapy has been used.