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Lower jaw mass can be odontogenic or non-odontogenic. Most common odontogenic tumor is ameloblastoma and it is rare in female. Fibrosarcoma is also not uncommon in this area. Here we are presenting a 44 years Bangladeshi previously healthy female who noticed a slowly growing huge mass in her lower jaw [Fig.1,2] which gradually involved her left chin. She had difficulty in swallowing and mastication though little problem in speech. She was a neglected case due to low socioeconomic condition and came to our outpatient department two years after the onset of the problem. She was normotensive, non-diabetic, nonicteric and had no anemia. Her lymph nodes were not palpable and mass was nontender, stony hard and smooth. X-ray revealed bony type radio-opacity with features of new bone formation over her involved area and FNAC report was suggestive of fibosarcoma. Plan of surgical excision was made but patient denied to do it!


Discussion

Ameloblastoma is a common odontogenic tumor originating around the jaw area [1]. It is a benign tumor though rarely can metastasize. It has abnormal cell growth and easily infiltrates surrounding bony tissues and can destroy it. Surgical excision is required to treat this disorder.  Untreated tumor can obstruct the nasal and oral airways and produce breathing difficulty [1]. Fibrosarcoma is a malignant neoplasm of mesenchymal cell origin and histologically predominant cells are fibroblasts. It is uncommon in the head and neck and constitutes less than 1% of malignancies and approximately 6% of the soft tissue sarcomas [2].  It can invade local tissues and can metastasize. Fibrosarcoma equally affects men and women. Tumors can occur in any age but are most common between the third and sixth decades [3]. Ameloblastic fibrosarcoma is a rare odontogenic malignancy distinct from fibrosarcoma of bone [4]. It is characterized by areas of a benign odontogenic epithelium interspersed with areas of fibrosarcoma. Here our case was diagnosed (confirmed) by FNAC as fibrosarcoma though excisional biopsy and confirmation by histopathology could not be possible.

References

1. Reichart PA, Philipsen HP, Sonner S. Ameloblastoma: biological profile of 3677 cases. Eur J Cancer B Oral Oncol. 1995;31B(2): 86-99.
2. Richardson JF, Fine MA, Goldman HM. Fibrosarcoma of the mandible: A clinicopathologic controversy: Report of a case. J Oral Surg 1972;30:664-668.
3. Soares AB, Lins LH, Mazedo AP, Neto JS, Vargas PA. Fibrosarcoma originating in the mandible. Med Oral Patol Oral Cir Bucal 2006;11:E243-6.
4. Choi YS, Asaumi J, Yanagi Y, Hisatomi M, Konouchi H, Kishi K. Recurrence of an ameloblastoma in an autogenous iliac bone graft. Dentomaxillofac Radiol 2006;35(1):43–46.