Osteosarcoma — ORE Part 1 MCQ

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HardOral PathologyOsteosarcomaORE Part 1

A 65-year-old woman presents with unilateral facial swelling. CT shows a mixed radiolucent-radiopaque expansile lesion in the maxilla with a characteristic 'sunray' radiographic pattern and cortical destruction. What is the most likely diagnosis?

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Correct answer: B — Osteosarcoma of the maxilla

The diagnosis is osteosarcoma of the maxilla. The classic radiographic triad for osteosarcoma comprises: (1) mixed radiolucent-radiopaque appearance reflecting both bone destruction and neoplastic osteoid formation; (2) sunray (or 'orange peel') periosteal reaction representing interrupted periosteal ossification due to rapid tumour growth; (3) cortical destruction from aggressive intraosseous expansion. In series of jaw osteosarcomas, 60–80% show mixed density with 80% displaying sunray periosteal reaction. Although jaw osteosarcoma classically affects adolescents and young adults, it occurs in older adults (mean age 37, range 10–87 years); this patient's age is within the described range. Fibrous dysplasia presents with a fingerprint bone pattern and superior canal displacement without cortical destruction. Paget disease shows cotton-wool sclerosis diffusely, not localised expansile lesions with sunray pattern. Osteoma is radiopaque only (no radiolucency) and benign. Cemento-ossifying fibroma (also ossifying fibroma) typically affects younger patients, presents with slower growth, and lacks the characteristic sunray periosteal reaction.

Reference: Clinical and radiographic characteristics of osteosarcomas of the jaws: A retrospective study. PMC11392439 (2024). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392439/