Chondroblastic osteosarcoma: the wolf in sheep’s clothing

Abstract

Osteosarcoma (OS) is a rare but highly malignant bone tumour. Based on the extracellular matrix produced by tumor cells, conventional OS can be subdivided in fibroblastic, osteoblastic and chondroblastic types.1 Chondroblastic OS is defined as any osteoid and/or bone, produced by uncommitted mesenchymal cells without first passing through a cartilaginous phase, no matter what the extent of the chondromatous element

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Cukurova Medical Journal
Cukurova Med J 2018;43(3):761-762
ÇUKUROVA ÜNİVERSİTESİ TIP FAKÜLTESİ
DOI: 10.17826/cumj.397502
Yazışma Adresi/Address for Correspondence: Dr. Manas Bajpai, Department of Oral and Maxillofacial Pathology,
NIMS Dental College, Jaipur, India E-mail: dr.manasbajpai@gmail.com
Geliş tarihi/Received: 29.05.2017 Kabul tarihi/Accepted: 29.09.2017
EDİTÖRE MEKTUP / LETTER TO THE EDITOR
Chondroblastic osteosarcoma: the wolf in sheep’s clothing
Kondroblastik osteosarkom: koyun görünümünde kurt
Manas Bajpai1, Nilesh Pardhe1
1Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, India
Cukurova Medical Journal 2018;43(3):761-762
Dear Editor,
Osteosarcoma (OS) is a rare but highly malignant
bone tumour. Based on the extracellular matrix
produced by tumor cells, conventional OS can be
subdivided in fibroblastic, osteoblastic and
chondroblastic types.1 Chondroblastic OS is defined
as any osteoid and/or bone, produced by
uncommitted mesenchymal cells without first
passing through a cartilaginous phase, no matter
what the extent of the chondromatous element.2 A
49 year old male presented to the Out Patient
Department (OPD) of our Institution with the chief
complaint of painful swelling of the left lower back
region of the jaw since 3 months. The swelling was
initially small but gradually increased to the current
size. The pain was continuous, non – radiating and
aggravated on eating. Past medical history and
family history were not relevant to the presenting
symptom. Extra – oral examination revealed a
diffuse swelling of the face that caused facial
asymmetry. The left submandibular lymph nodes
were palpable. The swelling was tender on
palpation.Intra – oral examination revealed a bony
hard swelling extending from tooth #33 to the left
body of the mandible measuring about 3×3 cm. The
color of the swelling was red with areas of
ulceration. Panoramic radiograph revealed a mixed
radiopaque – radiolucent lesion extending from the
root of tooth #32 to the body of the mandible. The
roots of #34, #35, and #36 showed resorption.
Tooth #37 was missing and #38 was impacted. A
provisional diagnosis of osteosarcoma was given
and patient was referred to the oncology unit for the
treatment. Radical surgical resection along with
hemimandibulectomy was performed. Excised
specimen was sent to the Department of Oral and
Maxillofacial Pathology NIMS Dental College,
Jaipur, India (Figure 1), for histopathological
evaluation. The defect was restored by titanium
reconstruction plates. The follow up period of 1
year was uneventful.
Hematoxylin and eosin stained tissue revealed
numerous cartilaginous and osseous areas
interspersed in a sparse connective tissue storoma.
(Figure 2). Neoplastic bone formation was seen
lined by malignant osteoblasts, the stroma showed
areas of myxoid degeneration at places. (Figure 3)
There were highly cellular cartilaginous areas,
chondrocytes arranged in lacunae with nuclear
pleomorphism. (Figure 4)Based on histopathological
examination a final diagnosis of chondroblastic OS
was rendered.
Chondroblastic OS of jaw are rare tumors, account
for 50% of all the subtypes of OS and generally
show relatively better prognosis. The diagnosis of
chondroblastic OS is not possible on the grounds of
clinical and radiographic fatures.3 The
histopathological diagnostic criteria of
chondroblastic OS is comprised of areas cellular
cartilaginous tissue with dysplastic features with
varying amount of neoplastic bone formation.2,3
Diagnosis of chondroblastic OS often produces a
diagnostic difficulty and can be mistaken as
chondrosarcoma: especially in the cases when the
osteoid is absent in incisional biopsy and/ or in
unrepresentative tissue samples.3 Chondrosarcomas
are relatively uncommon in jaw bones and show
better prognosis than OS. According to
Garrington’s series of 45 cases, the overall 5 year

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survival rate for maxillary OS was 25% and for
mandibular OS, 41%.2 The overall 5 year survival
rate of chondrosarcoma is 67%.4 OS is sensitive for
chemotherapy and radiotherapy while
chondrosarcoma is resistant. The demarcation
between the two is mandatory to direct a proper
treatment approach.
Figure 1. Resected specimen.
Figure 2. Abundant cartilage and bone formation
(Hematoxylin and Eosin X10).
Figure 3 Neoplastic osteoids lined by malignant
osteoblasts. (Hematoxylin and Eosin X 20).
Figure 4 Cellular cartilaginous tissue with pleomorphic
nuclei and neoplastic osteoids formation. (Hematoxylin
and Eosin X40).
REFERENCES
1. Bajpai M, Pardhe N, Chandolia B, Arora M.
Osteogenic sarcoma of mandible. J Coll Physician
Surg Pak. 2017;27:26-27.
2. Garrington GE, Scofield HH, Cornyn J, Hooker SP.
Osteosarcoma of the jaws: analysis of 56 cases.
Cancer 1967;20:377-91.
3. Tossato Pdos S, Pereira AC, Cavalcanti MG.
Osteosarcoma and chondrosarcoma--radiographic
differentiation using computerized tomography.
Pesqui Odontol Bras. 2002;16:69-76.
4. Izadi K, Lazow SK, Solomon MP, Berger JR.
Chondrosarcoma of the anterior mandible. A case
report. N Y State Dent J. 2000;66:32-4.