OSTEOSARCOMA: A REPORT OF 2 CASES WITH SIMILAR RADIOGRAPHIC FEATURES

Abstract

Background Osteosarcoma is the most common primary malignant bone tumor of the jaws but is relatively rare.1-4 Osteosarcoma can be osteodestructive, osteogenic, or, more frequently, a combination of the 2.1,4 Osteosarcoma commonly occurs in the posterior mandible, but we report on 2 cases involving the anterior mandible, 1 occurring in a 20-year-old male patient (patient A) and 1 occurring in a 76-year-old male patient (patient B). Objective To describe the clinical and radiologic findings of 2 patients presenting with osteosarcoma in the anterior mandible. Clinical and Radiologic Findings Patient A presented with an intraoral swelling of 1.5 month duration and measuring 2 × 2 cm in size. There was loosening of teeth, but no pain or paresthesia was reported. The lesion extended from teeth #23 to #27. Periodontal ligament (PDL) widening was present on all teeth, being most notable on #26 and #27. Tooth #26 was displaced mesially. A patchy sclerotic bone pattern was present, with irregular thinning, expansion, and interruption of the facial plate. Adjacent to the alveolar bone, there was an irregular and unorganized density, similar to bone, at the level of #26 and #27. Patient B presented with a fixed, asymptomatic 2 × 2 cm intraoral swelling. Radiographically, a similar pattern of tooth displacement, PDL widening, and patchy sclerotic bone pattern was present. An unorganized density, similar to bone, was present adjacent to the facial plate. Differential or Definitive Interpretation Patient A and patient B: osteosarcoma versus chondrosarcoma. Discussion Widening of the PDL space is an important finding associated with malignant disease and may occur with sarcomas and non-Hodgkin lymphoma. 2,5 Widening of the PDL space was identified in nearly half the osteosarcoma cases reported by Fernandes et al.2 The combination of PDL widening, sclerotic bone pattern with bone formation, and higher incidence of osteosarcoma compared with chondrosarcoma can be used to identify osteosarcoma cases radiographically.