Misdiagnosis of osteosarcoma as cementoblastoma from an atypical mandibular swelling: A case report

Abstract

Abstract. Cementoblastoma is a form of benign odontogenic tumor, with the preferred treatment consisting of tooth extraction and follow-up examinations, while in certain cases, follow-up examinations without surgery are performed. Osteosarcoma of the jaw is a rare, malignant, mesenchymal tumor, associated with a high mortality rate and low incidence of metastasis. Cementoblastoma and osteosarcoma of the jaw are dissimilar in terms of their histological type and prognosis; however, there are a number of covert associations between them. The present study describes the case of a 20-year-old female with an unusual swelling in the left mandible that had been present for 2 years. The patient was initially clinically diagnosed with cementoblastoma; however, following pathological examination, a diagnosis of osteosarcoma was confirmed. A total mandibulectomy was performed on the left mandible, with a fibular osteomyocutaneous flap used for reconstruction. At the 6-month post-operative examination, the patient demonstrated normal occlusion and oral commissure, and no recurrence or metastasis was observed over 2 years of follow-up.

Differential diagnosis and clinical management of periapical radiopaque/hyperdense jaw lesions

“…Recently, a case of osteosarcoma very similar to benign cementoblastoma was reported, in which there was a well-defined high-density change in the alveolar ridge surrounding the root of a mandibular molar. 8 Radiographic features of osteosarcomas are quite variable, and, in the initial stage of the tumor, a widened periodontal ligament could be the only radiographic sign of the lesion; however, there are some osteosarcomas associated with the loss of visualization of the periodontal space and the destruction of the cortical plate. A sunray pattern may be seen in the osteosarcoma, which could correspond to a parosteal osteogenic reaction to the spreading of the tumor; 8,73,74 however, this sign is not pathognomonic.…”

“…8 Radiographic features of osteosarcomas are quite variable, and, in the initial stage of the tumor, a widened periodontal ligament could be the only radiographic sign of the lesion; however, there are some osteosarcomas associated with the loss of visualization of the periodontal space and the destruction of the cortical plate. A sunray pattern may be seen in the osteosarcoma, which could correspond to a parosteal osteogenic reaction to the spreading of the tumor; 8,73,74 however, this sign is not pathognomonic. 73 The variable radiographic features of the osteosarcoma make histopathological examination essential for its diagnosis.…”

“…4,7 However, there are a significant number of radiopaque lesions that are found in the periapical region, which could be equally relevant to endodontic practice. 8,9,10,11 Endodontic diagnosis is dependent on clinical and radiographic examinations. Periapical radiographs and cone beam computed tomography (CBCT) images represent important exams in the detection and diagnosis of inflammatory, dysplastic and neoplastic periapical diseases.…”

Current update on the diagnosis and management of head and neck hard tissue sarcomas

“…The differential diagnosis between OS and CS can be challenging radiologically, and both tumours can have inner cortical scalloping and increased intramedullary attenuation and bone metastasis from a distant primary should also be excluded . When affecting the jaw, OS and CS they can mimic cementoblastoma, but OS do not usually result in external root resorption, and there is no sharp border between the dentine of the root and the hard tissue component . Furthermore, OS and CS usually cause widening of the periodontal ligament, whereas no space is seen in cementoblastomas .…”

“…When affecting the jaw, OS and CS they can mimic cementoblastoma, but OS do not usually result in external root resorption, and there is no sharp border between the dentine of the root and the hard tissue component . Furthermore, OS and CS usually cause widening of the periodontal ligament, whereas no space is seen in cementoblastomas . In a meta‐analysis, positron emission tomography (PET) with CT showed excellent accuracy for staging, recurrence and surveillance of OS, and it has a role in assessing treatment response to following chemotherapy .…”