Benign fibrous histiocytoma: report of case

Benign fibrous histiocytoma is a rare and usually painless oral neoplasm found in adults that may affect either soft tissue or bone typically noted in their fifth decade. This case was found in a 32 year-old Caucasian male who presented with a fairly well circumscribed unilocular radiolucent lesion extending from the mandibular right first incisor to the left first premolar and reaching the inferior mandible on a panoramic radiograph. A bony window was created and the intrabony lesion was curetted. Multiple sections revealed a cellular tumor composed of uniform spindle-shaped cells arranged in a prominent whorled or storiform pattern. Scattered xanthoma cells, multinucleated giant cells, lymphocytes, and deposits of hemosiderin were noted throughout the lesional stroma. Although malignant fibrous histiocytoma of the bone is relatively well known, benign fibrous histiocytoma of the bone is very rare.     

Uncommon dermoid cyst presented in the mandible possibly originating from embryonic epithelial remnants

A case of an intraosseous dermoid cyst that had developed in the mandible of a 29-year-old-male is reported. The patient was admitted to our dental clinic complaining of pain in the right molar area of the mandible. The patient had no particular history of the present illness. A radiographic examination revealed diffuse bone absorption in the right molar area. A biopsy showed the lesion to be an intraosseous dermoid cyst which was surgically enucleated. Microscopic examination of the excised tissue showed it to be well circumscribed with fibrous tissues, and the cystic space lined by keratinized epithelium. In addition, sweat glands and hair follicle-like skin appendages were identified in the cystic wall, where a daughter cyst was also found. We suggested that this uncommon cyst had developed in the mandible, as a result of embryonic epithelium migration. The patient remained in good health during the three year follow-up.     

An unusual oral presentation of a metastatic basal cell carcinoma

A case report of a metastasising basal cell carcinoma is presented. The primary lesion was situated on the right upper lip with metastasis to soft tissue on the buccal aspect of the right molar region of the mandible. The literature regarding this unusual occurrence is reviewed.     

Mesenchymal chondrosarcoma in the mandible: report of a case with cytological findings

Mesenchymal chondrosarcoma is an infrequent malignancy of bone and soft tissue, characterized by its peculiar bimorphic histological pattern. The use of fine-needle aspiration (FNA) in the diagnosis of bone tumors is controversial. A 31-year-old woman presented with a mandibular lesion detected on routine examination for orthodontic treatment. Radiography revealed an ill-defined mixed radiolucency in the premolar region of the right mandible with invasive characteristics such as root resorption and widening of the periodontal ligament space of neighboring teeth. Blood clots obtained at FNA were fixed in formalin and exhibited spindle cells surrounding islands of pleomorphic chondroblasts against a bloody background. Histopathologically, clusters of spindle cells juxtaposed with mesenchymal tissue were detected, with a large hemangiopericytomatous component. In the present case, cytological findings combined with clinical and radiological data provided valuable information in establishing the diagnosis of malignancy and in planning further procedures and treatment.     

Cystic degeneration in fibrous dysplasia of the jaws: a case report.

A case of nonspecific cystic degeneration complicating fibrous dysplasia of the mandible is presented. This condition is extremely rare in the jaw bones. The patient had a painless swelling of the right face measuring 10 cm in diameter, and there was no history of trauma. Radiographs showed a poorly defined, "ground glass" radiopaque lesion; a central well-defined cyst was confirmed by means of computed tomography. During surgery, a large cystic cavity with surrounding, soft fibrous bone that merged with the cortex was observed. Histologic examination showed a large non-epithelial-lined cystic cavity with a surrounding fibro-osseous lesion, which was consistent with a diagnosis of fibrous dysplasia.     

Leiomyosarcoma presenting as a mandibular gingival swelling: a case report

We report a case of primary low-grade leiomyosarcoma of the mandible in an otherwise healthy young woman. The neoplasm presented as a painful, pericoronal gingival swelling that mimicked an acute periodontal infection. It was managed accordingly, with curettage, debridement, and antibiotics. When the lesion failed to respond to this treatment approach, a biopsy was performed. Microscopy revealed a malignant mesenchymal neoplasm which, on immunohistochemistry analysis, demonstrated reactivity for smooth muscle actin (SMA) and vimentin. This established the diagnosis of leiomyosarcoma; subsequently, an en bloc resection of mandibular bone and overlying soft tissue was performed. Close follow-up for over 10 years has revealed no evidence of recurrent or metastatic disease. Since the patient was taking oral contraceptives prior to the onset of the lesion, a possible link between estrogen and smooth muscle tumors is considered.     

Central adenoid cystic carcinoma of the mandible manifesting as an endodontic lesion

AIM: To present a case of adenoid cystic carcinoma (ACC) in the mandible, and manifesting as a periapical lesion. SUMMARY: A 56-year-old male suffered from pain around the right mandibular first molar for approximately 1 week. Oral examination revealed that the involved tooth was restored by a full coverage crown with no obvious abnormalities. A periapical radiograph revealed two ill-defined radiolucencies associated with the tooth, one over the mesial and another over the distal roots of the tooth; incomplete root filling and furcation involvement also being noted. The affected tooth was extracted based on the clinical impression of apical periodontitis. The surrounding tissue of the root apex was curetted and sent for histopathological examination, which revealed ACC. KEY LEARNING POINTS: Adenoid cystic carcinoma affecting the mandible may mimic a periapical lesion. Proper diagnosis of such a lesion is dependent on thorough clinical, radiographic and microscopic examinations. Such a case highlights the benefits of biopsy and histological examination of collected tissues. Diagnosis of lesions in the mandible should include salivary gland tumours.     

Extraosseous schwannoma of the mental nerve clinically simulating intraosseous

We report a case of a benign neurilemmoma arising from the right mental nerve. Schwannomas are rare neurogenic tumours that originate from Schwann cells of the peripheral nervous system. Frequent locations are the head and neck region. Most of the tumours occur in the soft tissue whereas intraosseous schwannomas are rare. This case report deals with a young patient who was referred to our hospital with an unidentified fast-growing tumour located mainly in the premolar region of the right mandible. The tumour presented as an expansive, unilocular, well defined, radiolucent lesion on orthopantomography. No expansion of the mandibular canal could be seen. Computerized tomography scans of the mandible helped to identify the solid nature of the tumour. A biopsy was necessary to make the final diagnosis and the tumour was then excised surgically. Postoperative magnetic resonance imaging scans and a histological examination of the surgical specimen showed no signs of neurofibromatosis type 2.     

Metastasis of colon adenocarcinoma to the mandible: A case report

Metastatic tumors to the oral cavity are uncommon. In this article, we report a case of metastatic adenocarcinoma of the colon to the mandible with imaging features. A 73-year-old man with a history of colon cancer and liver metastasis was referred to our hospital with a chief complaint of swelling and pain in the right mandible. Panoramic radiograph revealed a radiolucency with ill-defined margin. Computed tomography showed an osteolytic lesion with cortical bone destruction. Magnetic resonance imaging showed a round-shaped homogeneous intensity mass expanding from the mandible. Histopathological diagnosis revealed metastatic adenocarcinoma of the colon.     

Giant cell-rich osteosarcoma or giant cell reparative granuloma of the mandible?

Giant cell-rich osteosarcoma (GCRO) is a rare subtype of osteosarcoma, and no literature has reported occurrence in the mandible region up to now. In this article, we report a case of GCRO originating from the mandible in a 67-year-old woman who presented a history of painless mass located in the left side of the mandible after teeth extraction. The curettage biopsy histologic diagnosis is giant cell reparative granuloma before mandibulectomy surgery, but panoramic radiograph revealed an osteolytic lesion. The tumor was completely resected with segmental mandibulectomy and soft tissue with postoperative histologic diagnosis of GCRO. The free fibula osteomyocutaneous flap was performed to reconstruct the defect of the mandible and gingival mucosa. The patient received postoperative radiotherapy and chemotherapy. The 1-year follow-up situation is fine.     

下颌骨动静脉畸形的手术治疗

目的 探讨下颌骨动静脉畸型的治疗方法。方法 根据临床检查和血管造影确定畸形血管的血液供应，备术中结扎。采用颌下常规切口或口内升支前缘切口，暴露畸形血管的范围决定结扎血管的数量，去除颊侧骨皮质，刮除病变血管组织，如有松动牙可将其用单颌夹板固定。结果 2年后临床、X线和血管造影检查，下颌骨病变区完全骨化。没有复发，没有牙齿损伤，神经感觉恢复。结论 该手术方法可保留牙齿和下颌骨的连续性，可减少术中出血。     

A comparative study of magnetic resonance imaging versus computed tomography for the evaluation of maxillary and mandibular tumors

The relative value of magnetic resonance imaging (MRI) versus computed tomography (CT) for imaging benign and malignant lesions of the maxilla and mandible was studied in a group of 16 patients. The imaging methods were evaluated for their ability to detect the lesion and define lesion margins, soft tissue extension, and bone involvement. The abnormality was identifiable with both imaging methods. For benign cystic lesions of either the maxilla or mandible (50%), MRI was overall equal to or better than CT. Magnetic resonance imaging was superior to CT in the evaluation of lesion margins and soft tissue extent of disease, whereas it was equal or slightly inferior to CT in lesion detection and in the evaluation of bone involvement. In the imaging of malignant neoplasms (50%), MRI was overall superior to CT in all four categories reviewed. Magnetic resonance imaging also had the highest rate of correlation with clinical findings, either from physical examination or at the time of surgery.     

Intraosseous foreign-body granuloma in the mandible subsequent to a 20-year-old work-related accident

The purpose of this article was to describe the clinical and microscopic features of an intraosseous foreign-body granuloma in the mandible that developed after the traumatic implantation of metal fragments during a work-related accident. A 65-year-old male patient had a severe pain in the body of mandible. Clinical examination showed facial asymmetry and a scar, extending to the left mental region. Intraoral examination revealed a soft mass involving the left alveolar bone with normal appearance of the mucosa surface. Panoramic radiographs showed a radiolucent lesion along the mandible extending from the central incisive to the first molar. Computed tomography revealed an osteolytic mass in the same area. His medical history included a work-related accident twenty years prior to evaluation. During the biopsy an important amount of bright metal-like pieces surrounded by soft tissue were found. A microscopic examination showed a foreign body associated with an aggregation of multinucleated giant cells. The final diagnosis was a foreign body granuloma. Even though foreign-body granulomas in the mandible are rare lesions, dentists should be familiar with their features and include them in the differential diagnosis of tissue masses.     

Osteomyelitis of the mandible associated with autosomal dominant osteopetrosis: a case report

Osteopetrosis is a rare hereditary bone disorder presenting with variable clinical features and is characterized by an increase in bone density. The main clinical findings of the benign-type of osteopetrosis (autosomal dominant) are fractures and osteomyelitis of the mandible, leading to the detection of the disease. We report a case of autosomal dominant osteopetrosis with secondary mandibular osteomyelitis. Clinical and radiological patterns and treatment evaluation were assessed. The patient was referred for evaluation and treatment of an acute abscess in the left side of the face and osteomyelitis of the mandible. Several imaging studies were performed to assess the lesion and the adjacent bone and soft tissue structures. Treatment consisted of intravenous antibiotic therapy, debridement of the necrotic bone and sequestrum, and extra-oral drainage of the abscess, with submandibular access. Healing was uneventful.     

A large glandular odontogenic cyst of the mandible: report of case

Glandular odontogenic cyst (GOC) is generally considered uncommon, but several investigators claim there is a more frequent occurrence than previously thought. However these case reports lacked confirming data to validate their claim. On the other hand, it is possible that cases of central mucepidermoid carcinoma or later periodontal cyst might be viewed as glandular odontogenic cyst. This is a report of a case of a 70-year old male who presented with a firm swelling in the right side of his edentulous mandible. Radiographic examination revealed a multilocular radiolucent lesion in the mandible extending from the right first premolar to the left second premolar and reaching the inferior mandible. Clinical findings, the health history, and microscopic examination of excised tissue confirmed the diagnosis of GOC. The lesion was excised and post-operative healing was uneventful.     

Plasma cell granuloma with severe cortical bone destruction of the mandible appearing as a malignant lesion—A case report

We experienced a case of plasma cell granuloma of the mandible appearing as a malignancy in a 22- year-old man. Plasma cell granuloma tends to be diagnosed as a potential malignancy as radiography reveals irregular bone destruction with an obscure margin. Therefore, plasma cell granuloma is classified as an inflammatory pseudotumor which may occur in any organ or soft tissue, including lung, vagina, bladder, and larynx. In the present case, the lesion was initially diagnosed as a malignant lesion on the basis of imaging analysis, but was later diagnosed histopathologically as a inflammatory lesion. This report reinforces the existence of inflammatory pseudotumors in the oral region, as well as the need for clarification of the unknown nature of inflammatory pseudotumors.     

Stafne bone cavity--magnetic resonance imaging

A case of Stafne bone cavity (SBC) affecting the body of the mandible of a 51-year-old female is reported. The imaging modalities included panoramic radiograph, computed tomography (CT) and magnetic resonance (MR) imaging. Panoramic radiograph and CT were able to determine the outline of the cavity and its three dimensional shape, but failed to precisely diagnose the soft tissue content of the cavity. MR imaging demonstrated that the bony cavity is filled with soft tissue that is continuous and identical in signal with that of the submandibular salivary gland. Based on the MR imaging a diagnosis of SBC was made and no further studies or surgical treatment were initiated. MR imaging should be considered the diagnostic technique in cases where SBC is suspected. Recognition of the lesion should preclude any further treatment or surgical exploration.     

Extensive aneurysmal bone cyst of the mandible

The aneurysmal bone cyst (ABC) is a rare benign lesion with an incidence of approximately 1% to 2% of bone tumors mainly in patients of 10 to 20 years of age and requires an operative procedure involving complete removal.We present a rare case of a large ABC in the angle and ramus of the mandible of a 14-year-old boy. The lesion had first been seen by a pediatrician 3 months before and turned out to be causing both a large and rapidly increasing swelling of the right face. Histology revealed a solid ABC, located in the angle and ramus of the mandible with cortical perforation and extrusion of the neighboring structures. A segmental resection of the mandible and soft-tissue excision of the lesion was performed. The mandible was primarily reconstructed by microvascular free-fibula transfer.The ABC did not show specific clinical or radiologic signs based on varying clinical examinations. The diagnosis was thus challenging, and other malignant tumors that can occur in the maxillofacial field had to be considered. Aneurysmal bone cysts mainly occur in patients 10 to 20 years old, so it is of clinical significance for pediatricians and pediatric dentists, who may well be the first to see such patients. This case report shows an ABC unusual in both its clinical findings and the therapy necessary. This article gives a conclusive review of diagnosis, pathogenesis, and treatment options.     

Haemophilic pseudotumour of the mandible in a 5-year-old patient

A haemophilic pseudotumour was identified in the mandible of a 5-year-old male with severe haemophilia A. The patient initially experienced painless swelling of the mandible. Computed tomography revealed a marked enlargement of the lower right mandibular border, which was associated with a low-density area, and irregular absorption of the lingual cortex bone. A malignant tumour was suspected, and a biopsy was performed after the administration of coagulation factor (Factor VII). A histopathologic diagnosis of haemophilic pseudotumour was made and the patient subsequently underwent surgical treatment. A cavity was created in the multilocular bone cyst and surgical curettage and irrigation were performed with the same haemorrhagic control as in the biopsy procedure. The multilocular cyst was contained within a haematoma and was surrounded by thin granular tissue. Three years after surgery, no abnormal signs have been detected by radiography during follow-up examinations. This case involved a rare haemophilic pseudotumour located in the mandible; the pathogenetic mechanism was attributed to pressure necrosis due to intraosseous bleeding.