Chondrosarcoma of the Mandible: A Challenging Lesion

Abstract

Chondrosarcomas of the maxillofacial region are rare and account for 1-3 of chondrosarcomas of the entire body with a predilection towards the anterior maxilla and a lower incidence in mandible. Clinical and radiographic findings are non-specific hence histopathological evaluation forms the basis for definitive diagnosis. This is a case of a 27-year-old female with a complaint of pain and swelling in her lower right back tooth region for one month. The swelling caused gross facial disfigurement with no secondary changes. Intraorally the growth involved both buccal and lingual sulci causing mobility of involved teeth. Radiographically severe periodontal bone loss was noted surrounding 47. Incisional biopsy was taken and sent for histopathological evaluation. The histopathological examination revealed lobular pattern of growth filled with sheets of round to polygonal cells showing pleomorphism and bizarre hyperchromatic nuclei along with a typical mitotic figures surrounded by densely packed spindle-shaped cells. In some areas chondroid matrix deposition with lacunae containing atypical chondrocytes was evident. Ki-67 IHC was done which showed 10 positivity. Hence the lesion was diagnosed as Grade I Chondrosarcoma. It must be differentiated from chondroblastic osteosarcoma as it bears close resemblance with it. The treatment is completely different for both entities. Chondrosarcoma is chemo-resistant and radioresistant whereas osteosarcoma is a highly chemosensitive tumor. Surgical resection is the treatment of choice in chondrosarcoma hence hemi-mandibulectomy was carried out in this case.