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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