What lies beneath: A Surprising Diagnosis of Oral Sarcoma
SL3 9BB
Davinder Bains
D Bains, Gillian Hall, Mustansir Alibhai, Barbara Carey
Background:
Oral sarcomas are rare malignancies, often presenting with non-specific signs that mimic common benign oral conditions. Early detection is challenging, particularly in younger patients, where malignancy is typically low on the differential. This case highlights the diagnostic dilemma posed by a deceptively innocuous gingival lesion.
Case Presentation:
A 27-year-old female presented with a painless, rapidly enlarging gingival lump in the UR2 region, initially presumed to be a bony exostoses. Clinical examination revealed a firm, non-tender mass with intact mucosa spanning the labial aspect of UR2 and UR3, with no associated lymphadenopathy. Initial radiographs showed no bony pathology. CT showed an ossific density with possible focal medullary involvement and aggressive features. Biopsy was performed, and histopathology unexpectedly revealed a chondroblastic osteosarcoma. Further imaging ruled out distant metastasis. The patient is undergoing neoadjuvant chemotherapy with surgery planned.
Conclusion:
This case underscores the importance of maintaining a broad differential diagnosis for oral hard and soft tissue lesions, even in young patients. Oral sarcomas can mimic benign pathology both clinically and radiographically, and timely biopsy remains key to early diagnosis and improved outcomes. Awareness and suspicion in atypical presentations can facilitate earlier intervention in these rare but aggressive tumours.
