Development of Chondroblastic Variant of Osteosarcoma After Root Channel Treatment in the Base of Maxillary Sinus

Case Report

A 21-year-old patient was admitted to the department of otolaryngology with complaints of swelling over the right side of the upper jaw for the last 6 past months. The patient also has difficulty in mastication as the size of the swelling had increased. The patient dental history was notorious for root canal treatment in the second molar tooth prior to the initiation of the swelling. The patient did not have any other illnesses and did not have any family history of malignancy. Of note, the patient did not have any notable addictions. The patient did not have any distant metastatic symptoms, and no other significant history of swellings anywhere else in his body. Physical examination in the department of otolaryngology revealed that around the second molar root expansible, rigid lesion was detected. Thus, the department of radiology was consulted and according to the patient’s maxilla-facial computed tomography (CT) showed that there was a 30×25 mm lesion in the nearby of the 2^nd molar tooth. Also, the lesion resulted in bone destruction in the maxillary sinus base of the patient. The lesion in the center had diffused calcifications inside of the mass spreading throughout the maxillary sinus to retro molar trigon. Due to the central calcification content in the central of the lesion, the possibility of osteogenic tumour was thought ([Fig. 1]). To learn the contrast pattern of the lesion, contrasted maxilla-facial MRI was requested. According to the T2W sequence demonstrated that there was an increase in peripheral hyper intensity around the calcification lesion. Contrasted sequences revealed that demarcated thin peripheral and a central nodular enhancement was observed. The other parts of the imaging did not show any abnormalities ([Fig. 2]). A core needle biopsy was performed through intraoral route and the result of the biopsy report demonstrated that there was a cartilage tumour containing irregular lobulated areas. New bone formation was noted in areas compatible with the osteoid. There were many atypical looking chondroblastic variant of osteosarcoma cells. The result of pathological specimen was compatible with chondroblastic variant of osteosarcoma. Later, the patient was planned for mass excision.

Fig. 1 CT showing that there was a 30×25 mm lesion in the nearby of the 2nd molar tooth. Also, the lesion resulted in bone destruction in the maxillary sinus base of the patient. The lesion in the center had diffused calcifications inside of the mass spreading throughout the maxillary sinus to retro molar trigon.

Fig. 2 MRI showing the T2W sequence demonstrated that there was an increase in peripheral hyper intensity around the calcification lesion. Contrasted sequences revealed that demarcated thin peripheral and a central nodular enhancement was observed.

Publication History

Article published online:
11 December 2024