Unusual Presentation of a Sarcoma of the Mandible

A 24 year old female presents with complaints of pain and swelling to the right mandible.  A panorex radiograph was obtained that demonstrated a radiolucent trabeculated lesion extending from tooth #32 to the condylar neck.  Buccal and lingual soft tissue bony expansion was evident on clinical exam.  Two biopsies were obtained; the first was inconclusive and the second demonstrated a giant cell reparative granuloma.  Upon composite resection of the right mandible and reconstruction with a vascularized free fibula flap, final pathology resulted in a diagnosis a low grade fibrohistiocytic sarcoma.  The incidence of a sarcoma of the mandible is extremely rare, with 32 confirmed cases reported in the literature.  We present the misdiagnosis from a benign pathological case of a giant cell reparative granuloma to a malignant fibrohistiocytic sarcoma.