COM August 2005

This is a 31-year-old white male who was referred by Dr. Jason Hilde for the evaluation of a lesion in the right posterior mandible noted on a routine dental radiograph (Fig 1). The clinical examination revealed a palpable swelling in the right mandibular buccal vestibule adjacent to teeth #s 27 & 28. The patient noticed the swelling a few weeks ago. There is no evidence of pain, anasthesia or parasthesia.

Figure 1.. This is a panoramic view at first presentation demonstrating a well-demarcated to corticated, unilocular radiolucency between teeth #s 27 and 28. It is mildly displacing the teeth.

The past medical history is positive for glaucoma and appendectomy. He has no history of smoking and rarely drinks.

The clinical examination revealed a buccal swelling in the right posterior mandible involving teeth # 27 & 28 (Figs. 1& 2). This swelling obliterates the vestibule. The panoramic radiograph demonstrates a well-defined and partially corticated unilocular radiolucency between teeth #s 27 & 28. The teeth are mildly displaced and are vital.

Figure 1. This is a panoramic view at first presentation demonstrating a well-demarcated to corticated, unilocular radiolucency between teeth #s 27 and 28. It is mildly displacing the teeth.

Figure 2. This is an intra-oral photograph demonstrating a full-flap surgical procedure exposing the expanded buccal bone with obliteration of the vestibule.

The biopsy revealed an encapsulated neoplasm of odontogenic epithelial origin. It is surrounded by dense fibrous connective tissue wall. The neoplasm is made up of epithelial cells arranged in strands and whorls of cells (Fig 4) and duct-like structures (Fig 5). Clusters of calcified material are also present (not shown).

Figure 4. This is an H & E stained section at x 100 magnification demonstrating sheets of epithelial cells some are spindle-shaped and arranged in bundles surrounding clusters of cuboidal cells some arranged in duct-like structures.

Figure 5. This is an H & E stained section at x 200 magnification demonstrating duct-like structures some with an eosinophilic material. These structures are surrounded by bundles of spindle-shaped epithelial cells.