Slide 1
Chondrosarcoma
Chondrosarcoma is a malignant tumor of mesenchymal origin that
produces cartilage.
Clinical Features:Age: adults 47 mean age.Sex: males and females
equally.Symptoms:1-pain 2-headache 3-hemorrhage from tumor or from
teeth 4-sensory nerve defect 5-proptosis and visual disturbances
6-trimus or abnormal joint function .
Imaging features:
Location:-10% in facial bone in all cases.-maxilla and mandible
are equal.-In maxilla :anterior region.-In mandible : occur in
coronoid process ,condylar head and neck, symphyseal region.
Periphery and shape:Two types of lesions:1_slow growing tumors
:shape :round ,ovoid or lobulated .Periphery :well defined
,corticated may meld with normal bone or be perpendicular to the
orginal cortex giving sunray or hair end appearance .2-aggressive
lesion :ill defined , invasive ,infiltrative ,non
corticated..Internal structures:Some calcification within the
center called flocculent so it is mixed radiolucent radiopaque
appearance.
Some names to this appearance:-moth eaten-snow like
features-Granular or ground glass appearing of abnormal bone.
Irregular calcification
Chondrosarcoma in the condyle, areas of bone destruction and
some calcificationEffect on surrounding structers:Slow growing
often expand normal cortical boundries rather than rapidly
destroying them. Displace and resorp teeth.
Differential diagnosis:1- osteosarcoma: typical calcification of
chondrosarcoma may be absent.2-fibrous dysplasia: the periphery is
better defined and it alter lamina dura leaving thin PDL space.
Management :Surgical excision. Ewing sarcomaRare small round
tumor of neuroectodermal origin .
Clinical features:Age: between 5 and 30 years Sex:males twice as
femalesSymptoms: swelling ,pain ,loose teeth, paresthesia,
exophthalmos, ptosis,epistaxis , ulceration, shifted teeth, trismus
,cervical lymphadenopathy and sinusitis.Imaging features:
Location: rare, mandibular cases twice as maxilla ,in posterior
areas in both jaws.
Periphery and shape: not corticated ,ragged border, solitary ,
may cause pathologic fracture ,no typical shape.
Internal structures : destructive mostly ,radiolucent.
Effect on surrounding structures:1-Not common feature that
periosteal new bone formation in jaws compared to other
sites.2-mandibular neurovascular canal, inferior border of mandible
are effected.3-Does not cause root resorption but destroy the
supporting bone of adjacent teeth.Differential
diagnosis:1-Inflammatory lesions such as osteomyelitis:Sequestra
that found on it not present in ewing sarcoma, Inflammatory lesions
have reactive bone formation but it differ from periosteal bone
formation.2-Eosinophilic granuloma associated with laminar
periosteal bone formation whereas Ewing sarcoma in jaws does not
have this feature.3-Difficult to differentiate from chondrosarcoma,
fibrosarcoma and osteosarcoma.
Management:Surgery, radiation therapy, chemotherapy.
Ewing sarcomain left mandibular condyle ,irregular margin,
destruction of the medial cortex of the condyle and pathologic
fracture.Fibrosarcoma
Fibrosarcoma composed of malignant fibroblast that produce
collagen and elastin.Etiology: unknown ,may because of
radiation.
Clinical features:Age: mean age fourth decade.Sex: equally in
males and females .Symptoms:-slowly to rapidly enlarging mass.-if
in bone accompanied with pain and invade soft tissues so it appear
bulky and mucosa become ulcerated.-pathologic fractures may
occur.-sensory neural abnormalities.- trismus.Imaging features:
Location : mostly in mandible especially in the premolar molar
region.
Periphery and shape:-ill defined noncorticated ragged
border.-infiltrative so may underestimated in radiogragh.-in soft
tissue lesion saucer like shape in bone or invade as SCC.-sclerosis
in adjacent normal bone. Internal structures:Little internal
structures,Radiolucent mostly but may have bone formation if not
aggressive.
Effect on surrounding:-Destruction to alveolar process, inferior
border, cortex of neurovascular canal ,walls of the sinus ,nasal
floor.-teeth: displaced grossly , no root resorption, obliterated
lamina dura, floating teeth.-periosteal reaction
uncommon.Differential dignosis-If fibrosarcoma does not cause
enlargement rule out Multiple myeloma and intraosseous carcinoma
,infected cyst.-If exhibit enlargement and tissue mass rule out
chondrosarcoma , osteosarcoma and central desmoplastic
fibroma.-Ewing sarcoma and radiolucent osteosarcoma Difficult to
differentiate from this tumer.-Peripheral invasive SCC have
ulcerative surface while fibrosarcoma does not.
Management:Chiefly surgical ,radiation and chemotherapy
palliative tt.
Fibrosarcoma in right maxillary sinus has destroyed cortical
boundaries of the sinus ,zygomatic process, hard palate ,posteior
maxilla and alveolar process.Thank youName: Hawra Makki
HilalStudent number:20102050087