U n ive rs ity J D en t S c ie 20 15 ; 1(2) : 74 -76 ABSTRACT : Fibrosarcoma is malignant mesenchymal neoplasm of the fibroblasts that rarely affects the oral cavity proper and can cause local recurrences or metastasis. It constitutes about 1% of all the malignancies affecting the human race. This article presents one such rare case of fibrosarcoma originating in the mandible in a 24 year old man. 1 2 3 4 Arti S. Sachdev, Md. Asdullah, Arun Sachdev and Mohd. Naeem 1 2 Senior lecturer, Post Graduate Student, Department of Oral Medicine & Radiology, Career Post Graduate Institute of Dental Sciences & Hospital, Lucknow. 3 Senior Consultant, Dept of Medicine ; Vivekanand Polyclinic and Institute of Medical Sciences, Lucknow INTRODUCTION : Fibrosarcoma is a malignant neoplasm of the fibroblastic origin.1 Fibrosarcoma of head and neck area represents 5% of all malignant intraosseous tumors. It can occur in any location but mainly affects long bone particularly, and its occurrence in craniofacial region is about 15%, mandible being the most common site. Although fibrosarcoma has been reported in all groups, it is most commonly seen in the 3rd and 6th decades of life.2 Fibrosarcoma may arise as a primary tumor in any part of the jaws and may be classified as of either peripheral (periosteal) or central (endosteal) type.3 Secondary fibrosarcoma of the bone may be associated with fibrous dysplasia, Paget's disease, bone infarct or cyst, and/or osteomyelitis; it may also occur as a malignant transformation of giant-cell tumor of the bone or be induced by prior irradiation.4 Clinically, in the oral cavity the major symptoms are pain, swelling, paraesthesia, loosening of teeth and ulceration of the overlying mucosa. 5 Radiological imaging of fibrosarcomas reveals radiolucent lesions with a geographical moth-eaten or permeative pattern of bone destruction.6 Fibrosarcomas are graded from low to high malignancy after the FNCLCC grading system, depending on the number of mitotic figures, tumour differentiation and the presence of tumour-necrosis.7 The treatment of choice is radical surgery; radiation therapy and chemotherapy can be used in inoperable cases.8 The prognosis is highly dependent on the tumour- grading and the success of complete resection. This paper describes a case of fibrosarcoma originating in the mandible of a young male. CASE REPORT A 25 -year-old male patient reported to the department with the complaint of swelling in the lower front chin region since 2 months. The swelling was initially small pea sized and gradually increasing in size. Patient consulted a local practitioner who prescribed medication for a week. The swelling did not regress following medication. The swelling gradually increased to attain the present size and was associated with pain on palpation. There was no associated history of difficulty in speech & mastication , loss of appetite with weight loss and fever. Patient did not give any history of systemic illness or trauma to the head & neck region. The patient was a labour by profession. There was no significant contributing family history. The patient gave a history of tobacco chewing & smoking since 7 years. Extraorally, there was a diffuse irregular swelling in the lower 1/3 rd region of the face measuring approximately 8 x 4 cm extending from the right angle of the mouth across the chin to 1 cm away from the left corner of the mouth. Inferiorly on the right side the swelling extended 1 cm below the lower border of mandible, while on the left side it extended 3 cms below the lower border of mandible. The swelling was more prominent on the left side as compared to the right side. (Fig 1)The margins were diffuse and the overlying surface was lobulated. Skin over the swelling was smooth and stretched with a fibrosed sinus in the right parasymphyseal region. The swelling was firm and fixed to the underlying structures. Bimanual palpation revealed enlarged right and left submandibular lymph nodes. The nodes were non tender, hard in consistency and fixed to the underlying structure. FIBROSARCOMA OF THE MANDIBLE - A CASE REPORT Journal of Dental Sciences University Key Words: Fibrosarcoma, Mandible, Antoni Cells Source of support : Nil Conflict of interest : None Case Report 74
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University J Dent Scie 2015; 1(2) : 74-76
ABSTRACT : Fibrosarcoma is malignant mesenchymal neoplasm of the fibroblasts that rarely affects the oral cavity proper and can cause local recurrences or metastasis. It constitutes about 1% of all the malignancies affecting the human race. This article presents one such rare case of fibrosarcoma originating in the mandible in a 24 year old man.
1 2 3 4Arti S. Sachdev, Md. Asdullah, Arun Sachdev and Mohd. Naeem1 2Senior lecturer, Post Graduate Student, Department of Oral Medicine & Radiology, Career Post Graduate Institute of Dental Sciences & Hospital, Lucknow.3Senior Consultant, Dept of Medicine ; Vivekanand Polyclinic and Institute of Medical Sciences, Lucknow
INTRODUCTION : Fibrosarcoma is a malignant neoplasm
of the fibroblastic origin.1 Fibrosarcoma of head and neck
area represents 5% of all malignant intraosseous tumors. It
can occur in any location but mainly affects long bone
particularly, and its occurrence in craniofacial region is about
15%, mandible being the most common site. Although
fibrosarcoma has been reported in all groups, it is most
commonly seen in the 3rd and 6th decades of life.2
Fibrosarcoma may arise as a primary tumor in any part of the
jaws and may be classified as of either peripheral (periosteal)
or central (endosteal) type.3 Secondary fibrosarcoma of the
bone may be associated with fibrous dysplasia, Paget's
disease, bone infarct or cyst, and/or osteomyelitis; it may also
occur as a malignant transformation of giant-cell tumor of the
bone or be induced by prior irradiation.4
Clinically, in the oral cavity the major symptoms are pain,
swelling, paraesthesia, loosening of teeth and ulceration of
the overlying mucosa. 5 Radiological imaging of
fibrosarcomas reveals radiolucent lesions with a geographical
moth-eaten or permeative pattern of bone destruction.6
Fibrosarcomas are graded from low to high malignancy after
the FNCLCC grading system, depending on the number of
mitotic figures, tumour differentiation and the presence of
tumour-necrosis.7 The treatment of choice is radical surgery;
radiation therapy and chemotherapy can be used in inoperable
cases.8 The prognosis is highly dependent on the tumour-
grading and the success of complete resection. This paper
describes a case of fibrosarcoma originating in the mandible
of a young male.
CASE REPORT
A 25 -year-old male patient reported to the department with
the complaint of swelling in the lower front chin region since
2 months. The swelling was initially small pea sized and
gradually increasing in size. Patient consulted a local
practitioner who prescribed medication for a week. The
swelling did not regress following medication. The swelling
gradually increased to attain the present size and was
associated with pain on palpation. There was no associated
history of difficulty in speech & mastication , loss of appetite
with weight loss and fever. Patient did not give any history of
systemic illness or trauma to the head & neck region. The
patient was a labour by profession. There was no significant
contributing family history. The patient gave a history of
tobacco chewing & smoking since 7 years.
Extraorally, there was a diffuse irregular swelling in the lower
1/3 rd region of the face measuring approximately 8 x 4 cm
extending from the right angle of the mouth across the chin to
1 cm away from the left corner of the mouth. Inferiorly on the
right side the swelling extended 1 cm below the lower border
of mandible, while on the left side it extended 3 cms below the
lower border of mandible. The swelling was more prominent
on the left side as compared to the right side. (Fig 1)The
margins were diffuse and the overlying surface was lobulated.
Skin over the swelling was smooth and stretched with a
fibrosed sinus in the right parasymphyseal region. The
swelling was firm and fixed to the underlying structures.
Bimanual palpation revealed enlarged right and left
submandibular lymph nodes. The nodes were non tender,
hard in consistency and fixed to the underlying structure.
FIBROSARCOMA OF THE MANDIBLE - A CASE REPORT
Journal of Dental Sciences
University
Key Words: Fibrosarcoma, Mandible, Antoni Cells
Source of support : NilConflict of interest : None
CaseReport
74
University J Dent Scie 2015; 1(2) : 74-76
Fig-1 Fig- 2
Mouth-opening was reduced to 26 mm. Intraorally there was
a diffuse swelling measuring approximately 8 x 2 cm,
extending from distal aspect of 36 to distal aspect of 45. (Fig
2) On the buccal aspect the swelling extended from the
marginal gingiva obliterating the buccal vestibule and on the
lingual aspect it extended from the marginal gingiva
obliterating the lingual vestibule. Mucosa over the swelling
was pale and covered with pseudomembranous slough. The
surface over the swelling was lobulated with ill defined
margins. The swelling was non tender and firm in
consistency. It was fixed to the underlying bone associated
with slight buccal expansion of the bone i.r.t 34 35 and 36.
IOPA i.r.t. 31 32 41 and 42 revealed irregular loss of lamina
dura, bone loss and diffuse radiolucency in the periapical
region of 31 32 41 and 42. (Fig 3)There was alteration in
trabeculation of the alveolar bone. The mandibular occlusal
crossectional view showed irregular loss of lamina dura and
diffuse radiolucency in the periapical region i.r.t. 31 32 41 and
42 with sunray pattern of bone at the lingual cortical margin.