Primary Intra-Osseous Squamous Cell Carcinoma of the Mandible - A Case Report

Abstract

Primary intra-osseous squamous cell carcinoma (PIOSCC) is I. Case ReportA 48-year-old female reported to our department with a complaint of pain and swelling on the left side of lower one-third of the face since 3 months. She visited the dentist for the first time. She reported difficulty in mouth opening with no pus discharge or bleeding from the lesion. There was no relevant medical and family history. Nevertheless, the patient gave a history of tobacco chewing since 8 years, thrice/day. Extra-oral examination revealed a solitary lymph node which was present in the left sub-mandibular region which was palpable, firm in consistency and non-tender. A large and firm swelling was present in the left mandibular region measuring about 5 cm × 6 cm causing slight asymmetry in the left side of the face. The swelling was diffuse involving middle and lower third of the left side of the face extending from ala tragal line to 2 cm. below the inferior border of mandible supero-inferiorly. The swelling extended from angle of mouth to the posterior border of ramus of mandible antero-posteriorly [ Fig. 1]. Paresthesia was present in relation to left side of the lower lip. Mouth opening was reduced to 2 cm without deflection or deviation of mandible. On palpation, swelling was non-tender and firm in consistency without any local rise in temperature.Intra-oral examination revealed a Class I molar relation without any occlusal derangement. A diffuse swelling was present in the right buccal vestibule measuring about 1 X 1 cm. in dimension in relation to teeth 35,36. It was soft in consistency and tender on palpation. No obliteration of buccal vestibule was seen [ Fig. 2]. Patient had undergone extraction 4 months ago for 37. Grade II mobility was seen in relation to 34, 35 and 36. The alveolar socket of 37, 38 had completely healed with overlying mucosa appearing normal. II. InvestigationsPatient was advised for serology test for HIV 1&2, IOPA, orthopantogram (OPG) and Computed Tomography (CT). The immunological status of the patient was normal as she was seronegative for HIV 1 & 2. IOPA of 36 region showed an ill-defined radiolucency extending from the mesial aspect of 35 to the region posterior to 36 and extending from the periapical region of 35, 36 to the inferior border of mandible with no break in continuity in the inferior border of mandible [ Fig. 3].OPG showed a large ill-defined radiolucency measuring about 7ₓ8 cm in dimension and extending from the mesial aspect of 34 to the ramus of mandible antero-posteriorly and from the sigmoid notch involving the condyle and coronoid process to the inferior border of mandible supero-inferiorly. The borders of the radiolucency exhibited an irregularity. The internal structure was not homogeneous and there were mixed radiolucent and radio-opaque areas along with presence of bay within bay appearance which is a classical feature of malignancy [ Fig. 4].CT revealed a destructive lesion in the left half of the mandible extending from subcondylar to right ramus and angle of man...