PMC5458701_01
(a) Extraoral examination showing diffuse swelling on the right side of mandible. (b) Intraoral examination showing soft tissue growth on the right side of mandibular arch. (c) Radiographic picture showing an ill-defined mixed radiolucent and radiopaque lesion along the right side of body of mandible denoting irregular areas of osteolysis. (d) Cross-sectional occlusal radiograph of the right side of body of mandible showing bicortical expansion and presence of radial spicules which spread outside the lingual and buccal side of jaw bone giving sunray appearance.
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F1
Right submandibular lymph node was palpable, enlarged, firm to hard, and fixed (Fig. 1a). Surface appeared smooth with areas of depression at places (Fig. 1b). Panoramic radiograph revealed an ill-defined mixed radiolucent and radiopaque lesion along the right side of body of mandible denoting irregular areas of osteolysis (Fig. 1c). The cross-sectional occlusal radiograph of the right side of body of mandible showed bicortical expansion and presence of radial spicules which spread outside the lingual side of jaw bone giving sunray appearance (Fig. 1d).
(a) Gross tissue after specimen. (b) Post-operative photograph.
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F2
Grossly, there was extensive soft tissue destruction with an associated soft tissue mass (Fig. 2a).
(a) Fibrous spindle cell areas showing fibroblastic pattern. (b) Osteoblastoma-like osteosarcoma appearance. (c) Osteoid and tumor bone (white arrow) without osteoblastic rimming (black arrow) suggestive of osteoblastic osteosarcoma. (d) Numerous, vessels dilated and proliferating giving hemangiopericytomatous appearance (Staghorn type appearance).
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F3
Hence, the diagnosis was given as aggressive osteoblastoma/Osteoblastoma like osteosarcoma(Fig. 3b). The histopathology revealed abundance of osteoid and tumor bone without osteoblastic rimming suggestive of osteoblastic osteosarcoma (Fig. 3c). Other areas showed fibrous spindle cell areas where osteoid or tumor bone was scarce i.e. (fibroblastic/fibrohistiocytic type Fig. 3a). At focal places, vessels were numerous, dilated and proliferating giving a haemangiopericytomatous appearance (Fig. 3d) (Staghorn type appearance).