2026年 · 第106卷第17期

A 33-year-old female was admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Dali University due to "swelling of the left face for more than 2 months". Two months ago, the patient's left side of the nose was swollen, about the size of a "broad bean". After rubbing "Yunnan Baiyao", the swelling subsided, and then gradually grew to the size of a "quail egg". Previous history of "viral hepatitis B" for 7 years without medication. Physical examination on admission: the face was unsymmetrical, the left infraorbital swelling, the range was 4.4 cm ×4.0 cm, no redness, the skin temperature was the same as the surrounding normal tissues, the texture was slightly hard, there was no mobility, and the boundary with the surrounding tissues was unclear. The temporomandibular joint has good mobility, no tenderness, no bouncing, normal opening, about 3 transverse fingers, and the opening type is vertically downward. Visible in the mouth: permanent dentition, 18~27, 38~48, normal oral hygiene, second degree calculus, a small amount of pigmentation on the tooth surface, 36 maxillofacial caries, no redness and swelling of the gums, and no obvious abnormalities in other teeth and mucosa. Maxillofacial CT scan (Panel A) + enhanced (Panel B) showed a circular soft tissue density shadow of the left maxillofacial region, with a size of 2.44 cm ×2.81 cm, and the lesion protruding into the left maxillary sinus with anterior wall bone destruction. The edge of the lesion is clear, the density is uneven, and patchy, sandy calcification and "needle-like" tumor bone can be seen inside it, showing the sign of "sunlight halo"; The enhanced lesions were significantly unevenly enhanced, and the degree of marginal enhancement was higher. The patient underwent "left facial mass resection + adjacent skin flap repair" under general anesthesia. Postoperative pathology (Figure C, hematoxylin-eosin staining ×200) showed that tumor cells in poorly differentiated areas diffusely infiltrated (shown by blue arrows), medium size, obvious nucleoli, pathological mitotic images were common, and well-differentiated cartilage islands and bone tissues were scattered (shown by red arrows). Cartilage ossification, calcification and atypia were obvious, and binuclear/multinuclear chondrocytes could be seen, invading the envelope. Immunohistochemical staining showed (panel D, EnVision staining ×200): Ki-67 (machine staining +30%), Vimentin (+), S-100 (cartilage +), CKp (-), LCA (-), CD34 (vascular +), CD99 (+). Combined with the medical history, clinical manifestations and auxiliary examination results, the final diagnosis was mesenchymal chondrosarcoma.