Case report demonstrates extensive mandibular osteolysis without metabolic bone disease in a 67-year-old female, highlighting tumor-bone microenvironment interactions in aggressive oral cancer.
Rationale: Oral squamous cell carcinoma (OSCC) commonly invades the mandible by direct extension; however, near-total mandibular osteolysis is exceptionally rare. Patient Concerns: A 67-year-old female presented with a rapidly progressive ulceroproliferative lesion of the right mandible associated with extensive hemimandibular destruction. Diagnosis: Histopathology confirmed moderately differentiated OSCC. Advanced imaging demonstrated near-complete lysis of the right mandible with extensive soft-tissue infiltration and regional nodal disease, without distant skeletal involvement. Comprehensive biochemical evaluation revealed normal serum calcium, phosphate and parathyroid hormone levels, excluding paraneoplastic hypercalcaemia or metabolic bone disease. Treatment and Outcome: Owing to extensive loco-regional spread, probable distant involvement and limited reconstructive feasibility, the lesion was deemed non-resectable, and systemic chemo-immunotherapy was planned. Take-away Lessons: This case highlights a rare, locally aggressive osteolytic behaviour of OSCC mediated by tumour–bone microenvironment interactions rather than systemic calcium dysregulation, emphasising the need for individualised, biology-driven management strategies.
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Balaji et al. (2026) studied this question.
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