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P022
Primary intra osseous squamous cell carcinoma (PIOSCC): The Illusive radiolucent lesion

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Primary Intra Osseous Squamous Cell Carcinoma (PIOSCC): The Illusive Radiolucent Lesion 

Introduction

•Primary intraosseous squamous cell carcinoma (PIOSCC)1 is a rare type of squamous cell carcinoma (SCC) only found within the jaw bones; maxilla and mandible. Recently re-classified as Primary intraossseous carcinoma (PIC)2.

•Presents as a radiolucent unilocular lesion with well defined to poorly-defined edges which mimics many typical odontogenic cyst. Thus, may often be misdiagnosed. 

 
Case Report
•A 43 year old male referred by his GDP for a month history of pain radiating to the right ear and intermittent numbness on the right cheek & chin.
•Patient was otherwise fit and healthy
•After plain film imaging a radiographic diagnosis of a suspected benign odontogenic cyst was made
•Enucleation of the cyst and extraction of the LR7, LR8  was performed
•Histopathology revealed a primary intraosseous squamous cell carcinoma
•Subsequent MDT was held leading to segmental mandibulectomy, neck dissection of right levels I-IV with fibula free flap reconstruction.
 
Diagnosis 
•Primary intra osseous squamous cell carcinoma of the lower right mandible 
 
Conclusions 
•PIOSCC tumors can be hard to differentiate from odontogenic cysts on plain film radiographs.
•Specimens taken during surgery must be sent for histopathology as the definitive diagnosis PIC will drastically change the treatment plan.  
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