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SarcomasChondrosarcomaEwings sarcomaFibrosarcoma20.11.2014Enssaf Gssan Adnan SaforyMalignant tumor- arise from cartilage.4 Histologic subtypes : 1. Clear cell ,, 2.Dedifferentiated,, 3.Myxoid,, 4.Mesenchymal.Occur: *Centrally ,, *Periphery ,, *Soft tissue .2nd Chondrosarcoma ; if arise within "Malignant mesenchymal cells".

Chondrosarcoma2ClinicallyAdults (47 yr) // Males = Females .Firm or Hard mass (of long duration) normal mucosa/skin.Enlargement Pain ,, Headache ,, Deformity.Less common S/S Hemorrhage ,, Sensory nerve deficits ,, Proptosis ,, Visual disturbances,, Trismus + Dysfunction (TMJ).

3Imaging features: The Radiologic signs (misleading) & benign in nature.Its Slow growing ; (Periosteal new bone formation)- giving "sun-ray" appearance.

Location: Mand = Max . Mand > Coronoid process , Condylar (head/neck),, Symphyseal region . Max > Ant region. (where cartilage tissue present)

Periphery:Round, ovoid with well-defined borders (corticated ). Uncommonly >> ill defined and invasive.

Internally: Calcification centrally: (mixed RL & RO). Described as: 1.Flocculent snow like feaures. 2. Granular // ground-glass appearing. (F.D).Central Radiolucency (cartilage).

Effect: Slow growing lesion ; Expansion rather than Destraction. In Mand: Expansion > Inf border, Alveolar process, Condyle (cortical covering '+' ). In Max: Push walls > Sinus/ Nasal fossa.Erosion of Articular fossa . RR + Tooth displacement+ Periodontal ligament.

Differential diagnosis:1. Osteosarcoma; no calcifications.+ ill-defined.2. Fibrous dysplasia; (internal pattern similar-Granular). -has better defined borders. + age. + post. - RR + normal/thin periodontal ligament.

Management: Surgical. radiotherapy + chemotherapy . 5 yr SR // 10 yr SR.

Ewing's sarcoma:Endothelial myeloma / round cell sarcoma. Tumor of long bone; rare in jaws.Males > females ( 5 30 yr). Reported findings : Swelling, Pain, Loose teeth , Paresthesia, Ptosis, Epistaxis,Ulceration, Shifted teeth, Trismus, Sinusitis & Cervical Lymphadenopathy.

Imaging features:

Location: Mand > Max, (post region). Marrow space Extend Cortical plates.

Periphery: Ill-defined radiolucency. (Never corticated)No typical shape.Has Ragged border; b of Uneven bone destruction. Usually solitary & Pathologic Fracture .

Internally: Entirely Radiolucent. Destructive lesion with Little bone formation.

Effect: Stimulate the periosteum to produce New bone May affect: ID canal, Inf border of mand, Alveolar plates. No RR. Destroy supporting bone of adjacent teeth; Displacement.

Differential diagnosis:1. Inflammatory/ infectious lesions: EX. Osteomyelitis: -Have Sequestra & sclerosis internally. -S/S of infection! (fever ). 2. Eosinophilic granuloma: -Laminar periosteal bone reaction. (onion skin) 3. Osteosarcoma, Chondrosarcoma, Fibrosarcoma. older age older age older age mix RL+RO max-ant region may see sclerosis (usually) well-defined more destruction. calcification centrally

Management:- Rare tumor; No specific treatment.- Surgery, Radiation therapy & Chemotherapy alone/ in combination.

Fibrosarcoma

Neoplasm of malignant fibroblasts; produce Collagen & Elastin. Unknowing etiology! (may arise in Tissue received radiation). Equally in Males + Females (30- 39 yrs). 2 types: 1. Within bone; come with pain 2. peripheral lesion, (invade soft tissue; bulky lesion- clinically). if reach Large size; Pathologic Fracture , Neural abnormalities, Trismus (TMJ). Mucosa: initially normal may become Erythematous/UlceratedImaging features: Location: Mand > Max. (Post region). Periphery: ill-defined borders (ragged). (not corticated) Grow along bone. (Elongated through marrow space)Sclerosis may present- in adjacent normal bone . Soft tissue lesion may cause : Saucerlike depression in underlying bone/invade it SCC.

Internally: Entirely radiolucent . (with little internal structure)Long standing lesion: will stimulate residual / reactive osseous bone formation. Effect: Destruction (most common)1. Mand: Alveolar process, inf border, ID canal > are lost!. 2. Max: inf floor of sinus, Post wall of max, Nasal floor > destroyed. RR uncommon. // Teeth displacement (floating). periodontal ligament. + Periosteal reaction uncommon.

Differential diagnosis:1. Central malignancies: Metastatic carcinoma, Multiple myeloma, Intraosseous carcinoma. (No enlargement of jaw) 3.Grossly infected dental cyst. (ant max).4.Chondrosarcoma + Osteosarcoma ( have internal structures). (Cartilage// Osteoid). ( Extracellular matrix (material) the malignant cells produce.) 5. Ewing's sarcoma. (less destruction).6.Peripheral invasive SCC (ulcerative surface).

Management:Surgically. Chemotherapy & Radiation > to reduce pain.