Osteosarcoma presenting as an aggressive nodular mass in the region of the mandible

Osteosarcomas are highly malignant neoplasms of bone that are challenging to diagnose. These neoplasms often show atypical behavior. In the initial phase they may present as nondescript bony swellings with an indolent growth rate, only to become overtly aggressive and malignant towards the later phase of the disease. Similarly, the histological growth pattern of this neoplasm can be quite diverse, presenting with areas that mimic benign myofibroblastic tumors, giant cell granulomatous conditions and partial encapsulation. The final diagnosis of an osteosarcoma is often reached after thorough sampling and examination of multiple biopsy specimens. All these clinical features and histological diagnostic difficulties were encountered in a case of osteosarcoma affecting the right mandible of a 62-year-old Chinese woman described here. The diagnostic lessons accrued from this case are discussed.