Surgical Mx of osteosarcoma of the mandible: BMJ case report
A 69-year-old woman presented with complaints of tingling sensation over the right side of her lower lip for the last 5 months and a progressively increasing swelling over the right cheek for the last 2 months.

On clinical examination, an ill-defined, non-tender mass with bony hard consistency was noted in the right body of mandible, which was fixed to underlying bone. She underwent a contrast-enhanced CT (face and neck), which revealed a mixed lytic–sclerotic lesion with poorly circumscribed margins situated in the body of the mandible on the right side along with a sunburst periosteal reaction (figure 1).

A contrast-enhanced MRI (face and neck) further revealed bone marrow oedema adjacent to the lesion (figure 1). A biopsy from the lesion suggested a diagnosis of chondrosarcoma and a systemic staging evaluation was normal.

Histopathological evaluation of the surgical specimen revealed a chondroblastic osteosarcoma (grade 3) with a microscopically involved anterior bony margin and no involved lymph nodes (0/11 nodes positive). Immunohistochemical evaluation revealed positive labelling for vimentin, with a Ki-67 index of 30%–40% (figure 2).

The final diagnosis of the patient was a chondroblastic osteosarcoma of the mandible American Joint Committee on Cancer stage IIA (pT1 pN0 cM0 G3). After an uneventful postoperative recovery, the case was reviewed in a MDT and due to the presence of positive surgical margin, she was advised adjuvant radiotherapy with image-guided volumetric modulated arc technique.

She received 66 Gy in 33 fractions over 6½ weeks (figure 3). The patient tolerated treatment well and developed Radiation Therapy Oncology Group grade 2 skin toxicity. On follow-up evaluation at 2 weeks, her skin toxicity had resolved and a whole-body 18flourodeoxyglucose PET CT done 3 months later revealed no recurrence. At the time of last follow-up, she has been disease-free for 6 months.

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