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High-grade osteosarcoma of the mandible: a rare tumor successfully treated with surgery and image-guided volumetric modulated arc therapy
  1. Irfan Ahmad,
  2. Chandi Prasad Bhatt,
  3. Irfan Bashir,
  4. Sandeep Rathour
  1. Department of Radiation Oncology, Batra Hospital and Medical Research Centre, New Delhi, Delhi, India
  1. Correspondence to Dr Irfan Ahmad, irfan.a{at}icloud.com

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Description

A 69-year-old woman presented with complaints of tingling sensation over the right side of her lower lip for the last 5 months and a progressively increasing swelling over the right cheek for the last 2 months. On clinical examination, an ill-defined, non-tender mass with bony hard consistency was noted in the right body of mandible, which was fixed to underlying bone. She underwent a contrast-enhanced CT (face and neck), which revealed a mixed lytic–sclerotic lesion with poorly circumscribed margins situated in the body of the mandible on the right side along with a sunburst periosteal reaction (figure 1). A contrast-enhanced MRI (face and neck) further revealed bone marrow oedema adjacent to the lesion (figure 1). A biopsy from the lesion suggested a diagnosis of chondrosarcoma and a systemic staging evaluation was normal.

Figure 1

(A, B) Contrast-enhanced CT slices in axial and coronal plane demonstrating a poorly circumscribed mixed lytic–sclerotic lesion in the body of the mandible on the right side, with cortical disruption (numbered arrow 1), periosteal reaction of sunburst type (numbered arrow 2) and accompanying heterogeneous soft-tissue mass (numbered arrow 3). (C, D) Axial T2 and T1 post-contrast sequence demonstrating the lesion abutting the right masseter muscle (numbered arrow 1) and causing alteration in the signal …

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