Case report
Chondrosarcoma is a malignant neoplasm that is characterized by formation of cartilage, with progressive local invasion to the surrounding tissue. Currently, it is known as the second most common bone tumour, after osteosarcoma. Chondrosarcomas occur in patients of all ages and the majority of them are over 50 years old. No significant gender or race predilection is noted yet.
Clinical manifestations of mandibular chondrosarcomas are presence of an enduring mass, painless swelling or sometimes pain, paresthesia and trismus. Tooth mobility is observed in advanced stages of chondrosarcoma which is possibly attributable to the widening of the periodontal ligament space and to the bone loss as well, a condition which may resemble periodontal lesions. Radiographical features of this malignancy are presence of erosive radiolucent area with ill defined borders that may include calcification. In fact, bone destruction is often detected and occasional opacities caused by calcification are observed.
Case Report
A 34-years-old woman referred to the Dental School of Isfahan University of Medical Sciences, presenting with a small hard swelling in front of her right ear. When mouth was in its maximum opening situation, patient complaint of pain in the right temporomandibular joint area and mild malocclusion without any jaw deviation was also detectable.
The pain and swelling had been present for 2 months. There were no complaints of malocclusion or pain in chewing activities. Intraoral examination showed no notable features. Further screening examinations showed that there was no cervical lymphadenopathy and all cranial nerves were intact. Extraoral examination revealed indurated domeshaped swelling, sized about 3×2×1cm situated in front of right ear with unnoticeable facial asymmetry as the swelling was masked by the patient’s hair. The overlying skin was intact and normal. Panoramic radiograph showed erosion in the head of condyle. An expansile lytic lesion involving the condyle was seen in computed tomography. The radiographic diagnosis was a malignant intra-osseous neoplasm.
According to clinical and radiographical features, differential diagnoses were chondrosarcoma, osteosarcoma, and Ewing’s sarcoma. Under general anaesthesia the tumour was exposed through a preauricular incision. The whole right condyle was resected. In macroscopic or gross examination, the excisional biopsy specimen was a gray-brown, cream coloured piece of head of condyle (40×30×20mm) with presence of cartilage and the cut-surface showed a lobulated pattern.
Microscopic findings showed proliferation of chondroblasts in atypical lacunae that were arranged in lobular patterns with pleomorphism and mild- tomoderate nuclear hyperchromatism in dysplastic chondroid matrix. In some lacunae, there was binucleated or multinucleated chondroblasts. In addition there was ischemic necrosis and margins of tumour were not involved.
Based on these findings, our diagnosis was chondrosarcoma (Grade II). After condylectomy; the patient did not receive any other treatment. Therefore we decided to follow up the patient at regular intervals. The patient is in a good condition now.
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