COM May 2012

Case of the Month Archives

Large, Well-Demarcated Expansile Radiolucency, Right Posterior Mandible

Dolphine Oda, BDS, MSc
doda@u.washington.edu

Contributed by: Dr. Pardeep Brar
Oral & Maxillofacial Surgery, Anacortes, WA

Case Summary and Diagnostic Information

This is a 17-year-old white female who presented with an expansile and well-demarcated radiolucency with scalloped border involving teeth #s 27-32.

Diagnostic Information Available

History of present Illness

This is a 17-year-old white female who presented with an expansile and well-demarcated radiolucency with scalloped border involving teeth #s 27-32 (Figure 1). The radiographic images demonstrate a large and well-defined unilocular radiolucency with scalloped border, pushing tooth #32 posteriorly and thinning the inferior border of the mandible. The radiolucency is clearly expansile (Figure 1) but otherwise asymptomatic. It is of unknown duration and the associated teeth are vital.

Figure 1. This combination radiograph was taken at first clinical presentation. Note the large, well-defined and expansile unilocular radiolucency with scalloped border involving area of teeth #s 28-32. Also note the thinning of the inferior border of the mandible with inferior expansion.

Medical History

The patient’s past medical history is negative for any significant disease or risk factors.

Clinical and Radiographic Findings

The patient was not aware of the lesion until very recently when the swelling of the right posterior mandible was felt. All the associated teeth are vital.

Excisional Biopsy

Treatment

Under local anesthesia, an incisional biopsy was performed. The area was sutured and the specimen submitted for microscopic evaluation. Based on the biopsy results, the patient was referred to another surgeon for a definitive treatment.

Incisional Biopsy

Histologic examination reveals multiple small pieces of soft tissue composed of a neoplasm of odontogenic epithelial origin surrounded by fibrous connective tissue (Figure 2). The neoplasm is made-up of epithelial islands one shows evidence of a clear cystic configuration (Figure 3). The basal cell layer surrounding the epithelial islands is palisaded. The epithelial layers above the basal cell layer are stellate and squamous epithelium in type exhibiting spongiosis. These islands are surrounded by dense fibrous connective tissue.

Figure 2. Low power (x40) H & E histology illustrates odontogenic epithelial islands surrounded by dense fibrous connective tissue. The larger of the three islands shows evidence of cystic arrangement while the other two are solid with acanthomatous epithelium filling the center.

Figure 3. Higher power (x100) H & E histology illustrates one cystic odontogenic epithelial island with hyperchromatic and palisaded basal cell layer covered by stellate reticulum type epithelium.

After you have finished reviewing the available diagnostic information

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