Radiographic features of intercrestal and classic osteosarcoma: a report of 3 cases

BACKGROUND With this poster we add 2 new cases of intercrestal osteosarcoma to the 2 cases reported at the 2017 AAOMR annual meeting in the poster entitled, “Osteosarcoma: A Report of Two Cases With Similar Radiographic Features.” One of the present intercrestal cases was clinically thought to be a “gingival epulis.” These 2 additional cases serve to raise awareness of the importance of recognizing the radiographic features of osteosarcoma occurring in an intercrestal location. In addition, we present another case of osteosarcoma with the classical features of sunburst bone pattern, knife-edge root resorption, and periodontal ligament (PDL) widening. With these cases and the authors’ own experience it is certainly true that osteosarcoma is the most common primary malignant bone tumor of the jaws.1 CASE REPORT Intercrestal case 1: A young male patient presented with clinical swelling in the area of teeth #26 and #27. A panoramic radiograph revealed unilateral PDL widening on teeth #26 and #27 and displacement of these teeth. There was growth of the intercrestal bone and a patchy sclerotic nature to the interradicular bone pattern. Intercrestal case 2: A 63-year-old white female patient presented with a gingival nodule of 2 months’ duration. Periapical and panoramic radiographs revealed PDL widening along tooth #21, displacement of teeth #20 and #21, growth of the intercrestal bone, and subtle radiolucent and radiopaque changes in the interradicular bone. Classical osteosarcoma case: A 53-year-old African American female patient presented with an expansile 2 × 2 cm firm, painful lesion associated with the mandibular left second molar. Panoramic and cone beam computed tomography images revealed a radiopaque bone pattern, PDL widening, tooth displacement, spiked root resorption, and sunburst bone pattern. DISCUSSION/CONCLUSIONS Intercrestal osteosarcoma may be a subtle relative of the expansion associated with the classic sunburst pattern. Meticulous attention to details is crucial during radiographic evaluation.