Mandible with ossifying osteochondrosarcoma.
GC.10311
Mandible, Portion of showing ossifying osteochondrosarcoma.
Removed by operation from a male aged 25. About two and a half years previously a swelling appeared on the inner side of the left mandible. This was removed locally through the mouth and histologically the lesion was considered to be an osteogenic sarcoma. Radiotherapy was advised but the patient very soon refused to continue with treatment. Two years later he reported at another hospital with a recurrent mass at the same site and. a biopsy confirmed the diagnosis of osteogenic sarcoma. Radical excision was considered more appropriate than radiotherapy and. the tumour-bearing segment of the mandible was resected together with the content of the digastric triangle. Recovery from the operation was satisfactory. Eight months later there was no sign of recurrence and. bone from the iliac crest was implanted to bridge the gaps in the mandible.
The resected portion of the left side of the mandible extends from the region of the canine tooth to near the tip of the coronoid and the base of the condyloid process. No teeth are present, but the appearance of the sockets of the canine and the first premolar suggest that these teeth were extracted to allow of section of the bone. The alveolar margin behind. these sockets has been absorbed. due, no doubt, to the teeth having been lost for some time.
On the medial aspect there is a projecting tumour measuring 5.5 cm. by 3 cm. It covers a large area of horizontal ramus, projecting a little above the alveolar margin and extending downwards to near the lower margin. In front it reaches the socket of the first premolar, and behind extends a little onto the ascending ramus above and to near the angle below. The surface is for the most part smooth and dark in colour. An oblique line indicates the attachment of the mucous membrane., the part above being ulcerated and exposed in the floor of the mouth. The mylchyoid, remnants of which can be seen, has been displaced downwards by the tumour.
Microsections show large areas of spindle-shaped cells in a loose fibrillar matrix, with dilated thin-walled vessels, some being lined apparently by tumour cells. Mitotic figures are few but the cells are irregular in size with occasional monster cells or multinucleated cells. In various parts of the tumour there are areas of osteoid tissue and nodules of well-formed cartilage. The tumour is an osteogenic sarcoma probably of a low grade malignancy.
Twentieth century, mid
