Atypical clinical presentation of mandibular osteosarcoma – a case report

Abstract

Background: Osteosarcoma is a malignant bone tumor most commonly affecting the long bones, whereas involvement of the jaws accounts for approximately 6-9% of cases. The atypical clinical behaviour, diverse radiographic presentation and degree of abnormal cellular morphology often pose challenge to clinician in arriving at definitive diagnosis. Advanced imaging modalities like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) reveal better anatomical details than the conventional radiography. However, Fluoro deoxy Glucose Positron Emission Tomography/Computed Tomography (FDG-PETCT) offers greater accuracy, sensitivity, and specificity in diagnosing osteosarcoma as it provides the functional and metabolic information coupled with anatomical details Objective: To highlight the diagnostic value of FDG-PETCT as an adjunctive imaging modality in identifying an atypical presentation of mandibular osteosarcoma. Case Report: A 29-yearold female presented with a swelling in the right lower jaw for two months. Initial evaluation made by contrast enhanced CT and histopathological examination, following incisional biopsy were inconclusive. Subsequent assessment with FDG-PETCT coupled with immunohistochemical analysis of SATB2 facilitated in arriving at a definitive diagnosis. This enabled timely surgical intervention and appropriate management. Conclusion: FDGPETCT plays a significant role in the early diagnosis, staging, and treatment planning of gnathic osteosarcoma. Therefore, it should be considered as an important adjunct in the diagnostic protocol for the management of osteosarcoma.

KEYWORDS

Bone neoplasms; Immunohistochemistry; Osteomyelitis; Osteosarcoma; Positron Emission Tomography Computed Tomography.