Osteosarcoma ex florid osseous dysplasia: report of a case

Abstract

History. A 36-year-old black woman presented to the Los Angeles County/USC General Hospital Dental Service with increasing pain and rapid swelling of the left face and jaw. Several weeks earlier, 2 mandibular molars had been extracted elsewhere because of pain, but her symptoms worsened. Marked swelling of the left face was observed. There was no evidence of local redness, heat, or drainage. Intraorally, marked nontender, lobular expansion of the left mandible was present. There was no paresthesia. Radiographs revealed a diffuse, ill-defined radiopacity with buccal and lingual expansion. Radiographs taken 3 years earlier (1997) disclosed bilateral radiopacities of the alveolar processes of the maxilla and mandible consistent with florid osseous dysplasia (FOD). There was no evidence of hypercementosis. A comparison of current films with a film of the affected area obtained in 1997 revealed a distinct change in a large lobular opacity of the left mandible. Biopsy was performed, and a diagnosis of high-grade osteosarcoma was made. Metastatic work-up was negative. A core biopsy specimen from the right mandible displayed microscopic changes compatible with cemento-osseous dysplasia. Resection was performed, and the diagnosis of osteosarcoma was confirmed. After discharge, the patient was lost to follow-up.