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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
CASE REPORT Table of Contents   
Year : 2003  |  Volume : 7  |  Issue : 2  |  Page : 52-53
 

Chondrosarcoma of the posterior maxilla: A case report


Department of Oral and Maxillo Facial Pathology, Sree Balaji Dental College and Hospital, Chennai, India

Correspondence Address:
Shantha Bharathan
Department of OMFP, Sree Balaji Dental College and Hospital, Narayanapuram, Chennai - 601 302
India
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   Abstract 

Chondrosarcoma is a malignant tumour characterized by the formation of cartilage by the tumor cells. Lesions of the jaw account for 1% of all chondrosarcomas reported. Most commonly, chondrosarcomas occur in the anterior portion of maxilla. However an unusual case of chondrosarcoma, which occurred in the posterior region of the maxilla, was encountered. Biopsy was taken from multiple sites of the tumour tissue and the histopathologic diagnosis was confirmed as chondrosarcoma.


Keywords: Chondrosarcoma, posterior maxilla


How to cite this article:
Bharathan S, Wadhwani R. Chondrosarcoma of the posterior maxilla: A case report. J Oral Maxillofac Pathol 2003;7:52-3

How to cite this URL:
Bharathan S, Wadhwani R. Chondrosarcoma of the posterior maxilla: A case report. J Oral Maxillofac Pathol [serial online] 2003 [cited 2020 Sep 20];7:52-3. Available from: http://www.jomfp.in/text.asp?2003/7/2/52/40939



   Introduction Top


Chondrosarcoma is a malignant tumor characterized by the formation of the cartilage, but not bone. It has been recognized as a separate entity only in the last 60 years [1] . This article documents a case report of this uncommon lesion in maxilla, an uncommon site.

In 1930, Phemister [2] defined sarcomas of bone that contained abundant cartilage as chondrosarcomas. Later, Ewing [3] supported the idea that chondrosarcomas and osteogenic tumours were distinct lesions. Lichtenstein and Jaffe [4] established criteria to classify chondrosarcomas. They defined chondrosarcomas as arising from full-fledged cartilage and never containing osteoid or bone stroma. Weiss and Bennett [5] reviewed the literature and documented a total of 161 Chondrosarcomas involving the head and neck. Garrington and Collett [6],[7] published a comprehensive summary of the retrospective analysis of 37 cases.


   Case Report Top


A 65-year-old male patient came with a complaint of swelling in the upper right side of the mouth extending towards palate .The lesion had been present for about three months. Patient gave the history of loose upper last molar, which he pulled out himself. According to him, from then on the lesion started to grow. There was no associated pain or paresthesia. On extra oral examination, nothing significant was seen. Intraoral examination showed a firm, sessile mass at the site of the extracted wound extending onto the palatal surface [Figure 1]. The lesion was non-tender and about 4x5cm 2 in size. Radiograph showed radiolucency with foci of radiopacities in the molar and the retromolar region. Biopsy was taken from multiple sites of the tumour tissue.


   Histopathology Top


Hematoxylin and eosin stained sections showed lobules of tumour tissue separated by thin fibrous septa. The central areas of the lobules demonstrated mature hyaline cartilage and the peripheral areas showed hypercellularity. These cells were round or spindle shaped [Figure 2]. The chondrocytes showed pleomorphism and hyperchromatism [Figure 3]. Though calcification was seen in some areas [Figure 4], malignant osteoid were absent.


   Discussion Top


Chondrosarcomas of the jaws are relatively rare and do not show sex predilection. The tumour can occur between 10-80 years of age [8] . The most common clinical presentation is a painless, enlarging mass, with cortical expansion. Resorption or exfoliation of teeth may occur before the onset of the lesion.

In the maxilla, the most common location of chondrosarcoma is the anterior alveolus [9] . However in our case, the lesion occurred in the posterior maxilla, which is an uncommon site. The radiographic survey may show radiolucent, radioopaque or mixed lesions that are relatively circumscribed or poorly demarcated [9] . The radiographic presentation of the present lesion was consistent with other reports.

The diagnosis is made by biopsy from different sites to establish the malignant nature of the lesion and to differentiate the chondrosarcomas from chondromas .The histology as first defined by Lichtenstein and Jaffe [4] , includes a richly cellular stroma with plump cells, some with multiple nuclei, hyperchromatism of the nuclei and irregularity in the size of the cells and their nuclei. According to Batsakis [10] , mitotic figures may be infrequent and their absence should not rule out a diagnosis of chondrosarcoma. Evans and coworkers have further classified chondrosarcomas into grades I, II and III on the basis of the mitotic rate, cellularity and nuclear size. The differential diagnosis of chondrosarcoma from chondroma is often difficult. In chondroma, a benign neoplasm, most of the cell nuclei are small and single .It is also less cellular than its malignant counterpart. It may be impossible to distinguish a well-differentiated (Grade I) chondrosarcoma from a chondroma [11] . Differentiation between chondroblastic osteosarcoma and chondrosarcoma is often necessary. In chondroblastic osteosarcoma, foci of malignant osteoid are present, which is not seen in our case.


   Conclusion Top


Chondrosarcoma is a malignant counterpart of chondroma, that occurs either in the maxilla or the mandible, as well as in many other bones in the body. We have presented a case of chondrosarcoma in a male patient in posterior maxilla, which is an uncommon site. Biopsy was taken from multiple sites of the tumour tissue and histological examination showed lobules separated by thin fibrous connective tissue septa. The central area of lobules showed mature hyaline cartilage surrounded by mesenchymal tissue containing round or spindle shaped cells. Serial sectioning of the tissue specimen revealed the same histological picture, which helped in confirming the diagnosis as chondrosarcoma.

 
   References Top

1.Berktold R, Krespi YR, Bytell DE, Ossoff RH (1984): Chondrosarcoma of the maxilla, Otolaryngol Head neck Surg, 92: 484-86.  Back to cited text no. 1    
2.Phemister DB (1930): Chondrosarcoma of bone, Surg Gynecol Obstet, 50: 216.  Back to cited text no. 2    
3.Ewing JA (1939): Review of the classification of bone tumours, Surg Gynecol Obstet, 40: 971- 76.  Back to cited text no. 3    
4.Lichtenstein and Jaffe HI (1943): Chondrosarcoma of bone, Am J Pathol, 19: 553-89.  Back to cited text no. 4    
5.Weiss WW, Bennett JA (1986): Chondrosarcoma, a rare tumour of the jaws, JOMS, 44: 73-79.  Back to cited text no. 5    
6.Garrington GE , Collett WK (1 9 8 8 ) : Chondrosarcoma I, A selected literature review, J Oral Pathol, 17: 1- 11.  Back to cited text no. 6    
7.Garrington GE, Collett WK: Chondrosarcoma II, of the jaws (1988): analysis of 37 cases, J Oral Pathol, 17: 12- 20.  Back to cited text no. 7    
8.Shafer WG, Hine MK, Levy BM (1974): Benign and malignant tumours of the oral cavity. In A textbook of Oral Pathology, Philadelphia, WB Saunders Co, pages: 165-6.  Back to cited text no. 8    
9.Chaudhary AP & Robinovitch MR (1961): Chondrogenic tumours of the jaws, Am J Surg, 102: 403-11.  Back to cited text no. 9    
10.Batsakis JG: Tumours of the head and neck, Clinical and pathological considerations, (2 nd ed.), Baltimore, The Williams & Wilkins Company, page: 384.  Back to cited text no. 10    
11.Hackney FL, Aragon SB, Aufdemorte (1991): Chondrosarcoma of the jaws, clinical findings, histopathology and treatment, Oral Sur Oral Med Oral Path, 71: 139- 43.  Back to cited text no. 11    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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    Abstract
    Introduction
    Case Report
    Histopathology
    Discussion
    Conclusion
    References
    Article Figures

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