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CASE REPORT CYST & TUMORS
Year : 2020  |  Volume : 10  |  Issue : 1  |  Page : 272-274

Enchondroma of the mandibular body: An occult entity


1 Savitri Dental Hospital and Maxillofacial Centre, Allahabad, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technology, Modinagar, Uttar Pradesh, India
3 Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India

Date of Submission04-Oct-2019
Date of Acceptance28-Mar-2020
Date of Web Publication8-Jun-2020

Correspondence Address:
Dr. Anmol Agarwal
Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technology, Modinagar, Uttar Pradesh
India
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DOI: 10.4103/ams.ams_226_19

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  Abstract 


Cartilaginous tumors are commonly encountered tumors that can involve almost any bone and very rarely found in the maxillofacial region. These tumors may have varied presentations ranging from a simple enchondroma to a high-grade osteo or chondrosarcoma. Owing to their membranous development they are reported to occur usually in the cartilage bearing areas of the jaws like condylar process of the mandible. This article is intended to present a rarest of rare case of enchondroma of the mandibular body which to the best knowledge of authors', is not reported in the literature so far.

Keywords: Cartilaginous, enchondroma, tumor


How to cite this article:
Shukla V, Agarwal A, Mittal G, Uppada UK, Rathi A. Enchondroma of the mandibular body: An occult entity. Ann Maxillofac Surg 2020;10:272-4

How to cite this URL:
Shukla V, Agarwal A, Mittal G, Uppada UK, Rathi A. Enchondroma of the mandibular body: An occult entity. Ann Maxillofac Surg [serial online] 2020 [cited 2020 Dec 5];10:272-4. Available from: https://www.amsjournal.com/text.asp?2020/10/1/272/286160




  Introduction Top


Chondroma is a benign tumor composed of mature hyaline cartilage[1] which can involve almost any bone of the body. Depending to its location, it can be classified as enchondroma or central chondroma, for the one located in the medullary cavity of the bone; periosteal or juxtacortical chondromas that originate adjacent to the periosteum below the cortical surface; and extraskeletal or soft tissue chondromas.[2] It is an extremely rare entity in the craniofacial region accounting for only 0.32%[3] where mandibular condyle and coronoid process are predominantly involved due to their cartilaginous nature.[4] We report a case of an enchondroma in the body of mandible which is an occult entity in the literature to date.


  Case Report Top


A 32-year-old female patient reported with a painless swelling in her lower left back teeth region for the past 5–6 months which was increasing gradually in size. Clinical examination revealed a well-defined, firm, and nontender swelling toward the buccal cortical plate measuring approximately 3 cm × 2 cm, extending from 34 to 36 region anteroposteriorly. There were no signs of discharge, and aspiration was found negative. Orthopantomogram revealed a well-defined radiolucency involving distal surface of 34 to distal surface of 36 [Figure 1]. Differentially, the lesion was diagnosed as giant cell granuloma or myxoma or ameloblastoma. Based on the clinical and radiological findings, we arrived at a provisional diagnosis of a benign odontogenic tumor.
Figure 1: Preoperative orthopantomogram

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Considering the small size of lesion, it was elected to perform excision intraorally under local anesthesia. Dissection was done [Figure 2] with utmost care to preserve the inferior alveolar neurovascular bundle which was closely associated to the lesion and the mass was excised in toto [Figure 3]. Histopathological analysis of the specimen revealed sheets of cartilage separated by fibrovascular tissue with a few tiny spicules of normal bone. Chondrocytes were seen within the lacunar spaces having small round nuclei with condensed chromatin, and eosinophillic cytoplasm which was suggestive of chondroma [Figure 4]. Nothing remarkable was noticed during the periodic follow-up clinically or radiographically [Figure 5].
Figure 2: Intraoperative dissection

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Figure 3: Excised tissue mass

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Figure 4: Histopathological analysis

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Figure 5: Postoperative orthopantomogram

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After correlating the clinical, radiological and histopathological findings, we came to a conclusion that this was a case of enchondroma of the body of mandible which is not yet reported in the literature.


  Discussion Top


Enchondromas are slow-growing, benign, cartilaginous tumors located in the medullary cavity of the bone and clinically asymptomatic. Commonly seen in the third or fourth decades of life with equal sex predilection,[1],[5] and most commonly involving short tubular bones of hand and long bones. Although rarely found in the jaw bones, condylar, and coronoid processes of the mandible are predominantly involved. In the present case, the patient presented with a gradually growing asymptomatic swelling in the mandibular left body which clinically appeared more to be a benign odontogenic tumor rather than anything else and was taken up for the management accordingly. It was only after the histopathological review that the chondromatous nature of the lesion was realized, leading it to be named as a chondroma. All this had driven the attention of authors' to review the literature on cartilaginous tumors of the jaw and establish a definitive diagnosis.

Occurrence of these tumors in noncartilaginous sites of the jaws had tempted some authors to refer them as hamartomatous growth.[4] However, some workers have proven that in such cases, aberrant embryonic cell rests and multidirectional differentiation of mesenchymal cells are implicated in the origin of these tumors.[6] Radiographically, these tumors demonstrate as a small radiolucent lesion without cortical involvement or soft-tissue extension.[7] While histopathologically, they reveal discrete islands of hyaline cartilage surrounded by lamellar bone which was in conjunction to the present case.

As per the little literature available, it is recommended that such lesions do not require any surgical intervention rather than observation. Occasionally, they have been found to be symptomatic and are treated by excision in toto. However, in the present case, the patient had reported with swelling of the body of mandible which was increasing in size gradually and was excised under the impression of benign odontogenic tumor. The reported incidence of recurrence for enchondromas is extremely low,[8] and the same was found in the present case after a follow-up of more than a year.


  Conclusion Top


Although literature is extremely sparse in such cases, and no concrete protocol is framed for their management, extreme caution should be taken, as an enchondroma could be the initial manifestation of osteosarcoma or chondrosarcoma; hence, long-term periodic follow-up must be considered mandatory. It is very much required that any modifications in the line of treatment of such rare cases that can be worked upon and implemented for future prospective.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Waldron CA, Chi AC. Bone pathology. In: Neville BW, Damm DD, Allen CM, Bouqout JE, editors. Oral and Maxillofacial Pathology. 3rd ed. Philadelphia: Saunders Elsevier 2009. p. 656-7.  Back to cited text no. 1
    
2.
Vanni, R. Bone: Chondroma. Atlas Genet Cytogenet Oncol Haematol. 2003;7:188-189. Available from: http://AtlasGeneticsOncology.org/Tumors/ChondromaID5147.html.[Last assessed on 2020 Apr 21].  Back to cited text no. 2
    
3.
Samir K, El Mofty. Bone lesions. In: Gnepp DR, editor. Diagnostic Surgical Pathology of the head and neck. 2nd ed. Philadelphia: Saunders; 2009;742-744.  Back to cited text no. 3
    
4.
Lazow SK, Pihlstrom RT, Solomon MP, Berger JR. Condylar chondroma: Report of a case. J Oral Maxillofac Surg 1998;56:373-8.  Back to cited text no. 4
    
5.
Vázquez Mahía I, López-Cedrún Cembranos JL, Ferreras Granado J, Lorenzo Franco F. Temporomandibular juxtaarticular chondroma: Case report. Med Oral Patol Oral Cir Bucal 2007;12:E171-4.  Back to cited text no. 5
    
6.
Kornbrot A, Tatoian JA Jr. Benign soft tissue tumors of the oral cavity. Int J Dermatol 1983;22:207-14.  Back to cited text no. 6
    
7.
Unni KK. Dahlin's Bone Tumors: General Aspects and Data on 11,087 Cases. 5th ed. Philadelphia: Lippincott-Raven; 1996.  Back to cited text no. 7
    
8.
Schreuder HW, Pruszczynski M, Veth RP, Lemmens JA. Treatment of benign and low-grade malignant intramedullary chondroid tumours with curettage and cryosurgery. Eur J Surg Oncol 1998;24:120-6.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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