A case of sublingual adenoid cystic carcinoma involving the mandible presenting as a “skip lesion”

Adenoid cystic carcinoma (ACC) is a slowly growing malignant neoplasm with a propensity for perineural invasion. Microscopic invasion of ACC often prevents its detection on computed tomography (CT) or magnetic resonance imaging (MRI). We herein report a rare case of sublingual ACC presenting as a “skip lesion” that rapidly infiltrated the mandible after tumor resection. A 64-year-old man presented to Okayama University Hospital with an 18-month history of swelling in the right floor of the mouth. Clinical examination displayed an ulcerated swollen mass in that region. An enhanced mass was detected in the right sublingual space on CT and MRI. Bone surface erosion was observed at the inferior border of the mandible, but continuity with the sublingual mass or mass around that lesion was not detected by imaging. Sublingual tumor resection and selective neck dissection were performed by the pull-through method. Histopathologically, the surgical margins were free of cancer cells, and the tumor was diagnosed as ACC. Continuity with the sublingual mass and mandibular bone was not detected intraoperatively. However, marked bone resorption was detected in the anterior mandible 3 months after the operation. Biopsy was performed, and the findings indicated the same histological type of sublingual ACC. This case suggests that a malignant tumor close to the jaw bone requires the clinician to consider the possibility of bone invasion and to observe a wide region surrounding the tumor using imaging examination.     

口腔颌面部恶性黑色素瘤的CT表现

目的：评价口腔颌面部恶性黑色素瘤的CT表现。方法：回顾性分析了经CT检查的口腔颌面颈恶性黑色素瘤病例15例(23灶)。CT检查包括平扫(15例,23灶)和增强(12例,19灶)。所有病例均经病理检查证实。结果：22/23灶恶性黑色素瘤在CT检查中呈阳性表现．包括原发病变14灶和颈部淋巴结转移性病变8灶。病变呈软组织肿块者20灶,黏膜增厚者2灶(均为原发灶)。病变边缘不清者18灶,边缘清晰者4灶。增强CT显示：不均匀强化者9灶,均匀强化者5灶,无强化者5灶。病变压迫颈静脉变形3灶,侵犯上颌骨7灶,侵犯下颌骨2灶。结论：口腔颌面部恶性黑色素瘤的CT表现具有多样性。病变多以边界不清并有增强的软组织肿块为特点。     

High-flow arteriovenous malformations of the mandible and the maxilla: report of 2 cases

Arteriovenous malformations (AVMs) are rare vascular lesions that can be life-threatening due to potential massive hemorrhage. AVMs can be subdivided according to the type of vessel involved (capillary, venous, and arterial) and can be categorized, according to hemodynamic features, into high-flow and low-flow lesions. AVM of the jaws is an uncommon disease. Clinical signs and symptoms of AVM may include pain, erythematous gingiva, spontaneous gingival bleeding, resorption and mobility of teeth, soft tissue discoloration, facial swelling, and asymmetry. Radiographically, AVMs are osteolytic and frequently have indistinct margins. Computed tomography can demonstrate enhancement of the lesions, while angiography can depict distended feeder vessels and arteriovenous shunts. Magnetic resonance imaging can visualize flow voids in high-flow abnormalities. The purpose of this paper was to present 2 high-flow cases of arteriovenous malformations: one with a large AVM lesion in the mandible that presented clinically as a discoloration on the mucosa and gingiva with loss of lip sensation; and the second with a lesion in the maxilla discovered during an extraction of a root fragment. Management of the lesions was achieved by embolization.     

Soft tissue aneurysmal bone cyst of the mandible: Report of a case

We report the case of a 17-year-old boy with a soft tissue aneurysmal bone cyst (STABC) located in the posterior aspect of the right mandible. Conventional radiography revealed no positive findings. On the computed tomography scan, the lesion appeared to have a non-uniform intralesional density. Magnetic resonance imaging revealed an abnormal soft tissue masses with cystic component in the superficial part of right mandibular body and angle with intact cortex. Following histopathological examination, fibro-histiocytic proliferation, blood-filled spaces and multinucleated giant cells were seen and the lesion was diagnosed as a STABC. The mass together with underlying bone and periosteum on its periphery was surgically resected under general anesthesia. Thirty-six months after surgery the patient was assessed at outpatient clinic and found no sign of recurrence This may be only the first reported case of the mandible in the English literature of this extremely rare benign tumor occurring in soft tissue.     

Atypical multiple benign osteoblastomas accompanied by simple bone cysts. A case report

A case of atypical benign osteoblastomas occurring at multiple sites in the maxilla and mandible of a 38-year-old woman, in association with simple bone cysts, is described. The tumors produced hazy or ground-glass-like semiradiolucent lesions with well-defined or poorly-defined margins on conventional radiographs. Histologically, the lesions were characterized by a proliferation of plump osteoblast-like cells forming trabeculae of osteoid and immature bone in a well-vascularized stroma. In addition, simple bone cysts associated with a radiolucent-radiopaque lesion consisting of lamellar bone and loose connective tissue were found next to one of the tumours. Possible pathogenesis of the tumours and cysts is discussed.     

29例头颈部炎性肌纤维母细胞肿瘤的CT及MRI影像学特征分析

目的: 探讨头颈部炎性肌纤维母细胞肿瘤 (inflammatory myofibroblastic tumor,IMT)的CT及MRI影像学特征,以提高该肿瘤的术前正确诊断。方法: 回顾性收集2012年1月——2018年12月上海交通大学医学院附属第九人民医院初诊并经术后病理检查证实的29例头颈部IMT患者,总结分析患者术前CT及MRI影像学表现。结果: 29例头颈部IMT患者中,67.0%（20/29）的患者术前被误诊为恶性肿瘤。头颈部IMT的影像学表现多样,局限性软组织内肿块7例,软组织肿块伴邻近骨质破坏12例（颞下窝5例,上颌窦6例,颌面部广泛软组织病变1例）,骨内肿块10例（上颌骨5例,下颌骨4例,颞骨1例）。89.7%（26/29）病灶边界不清楚;75.9%（22/29）病灶有骨质破坏,34.5%（10/29）病灶骨质破坏与骨质增生硬化并存。8例患者沿神经孔道侵犯邻近结构（6例发生于颞下窝,其中4例侵犯翼腭窝,沿圆孔、卵圆孔累及颅内,2例侵犯眶尖视神经管;2例发生于下颌骨,侵犯下颌神经管）。头颈部IMT在CT平扫时呈等或稍低密度, 未见钙化,增强扫描呈中度至明显强化。在MRI上,9例T1WI呈等或稍低信号;7例T2WI呈低信号;9例DWI呈高信号,ADC值约（0.6~1.0）×10^-3mm²/s。TIC曲线Ⅰ型7例,Ⅱ型2例。均未出现颈淋巴结及远处转移。结论: 头颈部IMT的影像学特征与恶性肿瘤相近,但骨质破坏的同时伴有骨质增生硬化,T2WI呈低信号,TIC曲线以Ⅰ型为主,极少发生颈淋巴结及远处转移。结合CT、MRI及功能学检查,可在一定程度上反映病灶的组织构成,为术前正确诊断提供重要依据。     

Radionuclide bone imaging in the differential diagnosis of head and neck lesions. A preliminary report.

The use of technetium 99m pyrophosphate (99mTcPP) imaging in the evaluation of benign and malignant tumors of the head and neck has been limited. In a clinical prospective study, twenty-one patients with suspected benign or malignant lesions of the temporomandibular joint, temporal bone, maxilla, or mandible were evaluated with regard to clinical presentation, radiographic findings, preoperative 99mTcPP bone scan, and final pathologic diagnosis. Eleven of twenty-one patients had positive scans at the site of biopsy-proven disease. In three cases, a bone scan was the single positive diagnostic test prior to surgical intervention. 99mTcPP imaging offers an additional noninvasive technique in the preoperative evaluation of patients with lesions of the osseous structures of the head and neck.     

Comparative study of clinical manifestation,plain-film radiography,and computed tomographic scan in arteriovenous malformations of the jaws

OBJECTIVE: The purpose of this study was to summarize the clinical manifestation, plain-film radiography, and computed tomographic (CT) scan features of arteriovenous malformations (AVMs) of the jaws on the basis of a series of 12 patients. STUDY DESIGN: This study group comprised twelve patients with AVM of the jaws from February 1996 to February 2001. Seven cases were located in the mandible, and 5 in the maxilla. Both plain-film radiography and CT scan were available for all cases. For the patients with lesions in the mandible, panoramic, posterioanterior, and lateral mandibular views were applied. Waters' position view and panoramic radiography were indicated for AVMs of the maxilla. RESULTS: Each patient with AVM of the maxillary bone had involvement of adjacent soft tissues. Various radiographic signs were noted, including erosion, coarse trabeculae, and apparent lack of any radiographic change, and CT scans featured cystic expansion of alveolar process with broken cortex. The radiographic signs and CT scan features of AVMs in the mandible were related to involvement of surrounding soft tissues. If involvement of the adjacent soft tissues was found, "soap bubble" radiolucency was shown radiographically and osteolytic expansion with perforation of cortex was present on CT scan. In cases without surrounding soft tissue involvement, the various radiographic signs included multilocular or unilocular radiolucency or coarse trabeculae; osteolytic expansions with intact cortex were found on CT scan. CONCLUSION: AVMs of the jaws showed intraosseous osteolytic expansion on CT scan but had variable appearance on plain-film radiographs.     

Diagnostic value of computed tomography,magnetic resonance imaging,and scintigraphy in diagnosing actinomycosis of the mandible

Mandibular actinomycosis is an uncommon disease caused by Actinomyces israelii. Actinomycosis infection typically manifests as a chronic disease resulting in multiple abscesses, firm soft tissue mass, and presence of sulfur granules in exudates or tissues. A few reports have provided imaging findings of actinomycosis in the head and neck, but computed tomography (CT), magnetic resonance imaging (MRI), and scintigraphy of mandibular actinomycosis have not been fully described. Here, we report a case of mandibular actinomycosis with CT, MRI, and scintigraphy. The purpose of this article is to characterize the CT, MRI, and scintigraphy findings in cases of actinomycosis. Contrast-enhanced CT of the masticator space showed heterogeneous enhancement and a nonenhancing portion, suggestive of necrotic foci. Bone tissue algorithm CT showed an osteolytic lesion in the ramus of the left mandible only. On post-contrast T1-weighted images, the masticator space showed heterogeneous enhancement and nonenhancing portion, suggestive of necrotic foci. Bone scintigraphy revealed monostatic involvement of the mandible with a homogeneous intense uptake pattern. Gallium scintigraphy revealed significantly increased uptake in the left side of the face. These findings can be helpful for differentiating actinomycosis from other tumors of the mandible.     

Magnetic resonance imaging findings of nodular fasciitis in the mental region

Nodular fasciitis (NF) is a benign reactive lesion of the soft tissues related to the fascia and characterized by fibroblastic proliferation. The most common site is the upper extremities (46%), followed by the head and neck region (20%). In the orofacial region, the lesion typically develops within the subcutaneous structures overlying the angle and inferior border of the mandible and the zygoma. Magnetic resonance imaging (MRI) findings of NF in the orofacial region are almost unreported in the literature. In the present case report, we describe MRI findings of mental NF in a 19-year-old woman. MRI revealed a well-defined, round soft-tissue mass lying on the mentum. On T1-weighted MRI, the lesion was isointense to skeletal muscle; it was hyperintense to skeletal muscle on T2-weighted MRI, and was enhanced by Gd-diethylenetriamine pentaacetic acid (DTPA). Histologic examination revealed abundant myxoid degeneration dispersed in the lesion. The T2-weighted higher heterogeneous signal intensity was likely due to abundant myxoid degeneration or the cellular component of the lesion. A strong bright signal intensity belt appeared in the periphery of the lesion on Gd-DTPA enhancement. This rim enhancement appearred to represent small arterioles and venules that were visible in the peripheral area on histologic examination.     

Static bone cavity in the condylar neck and mandibular notch of the mandible

This study presents the radiographic findings of two cases of static bone cavity in the inferior aspect of the condylar neck and mandibular notch of the mandible. On plain CT, a soft tissue mass was observed in each cavity. The submandibular gland and the other glands were not found in each cavity. On contrast-enhanced CT, the soft tissue in the cavity in the inferior aspect of the condylar neck had marked linear enhancement and dilated vasculature structure was observed in the cavity. On the contrast-enhanced MRI, the soft tissue in the cavity of the mandibular notch had marked enhancement and flow void was detected in the cavity. In the inferior aspect of the condylar neck, the cavity size had enlarged radiographically over a period of three years. Vascular lesions were found in the cavity located in the inferior aspect of the condylar neck and mandibular notch of the mandible by both CT and MRI. The vascular lesion might explain the enlargement of the static bone cavity.     

Low-Grade Osteosarcoma of the Mandible

Osteosarcoma (OS), a rare malignant bone tumour arising from primitive bone forming mesenchyme, most often arises in the metaphyses of long bones of the extremities. Bone or osteoid formation within the tumour is characteristic of an osteosarcoma. Craniofacial osteosarcoma (CFOS), most often located in the mandible or maxilla, accounts for only 5–13% of all osteosarcomas. In general, OS of the jaw is a high-grade lesion. Low-grade lesions are rare and represent less than 2% of all osteosarcomas reported in the literature. Because of its rarity and well differentiation, Low-grade OS is usually misdiagnosed as a benign lesion. The clinical and radiographic presentation does not correlate well with the subtle histology picture of a low-grade osteosarcoma which makes the diagnosis difficult.     

Enormous aneurysmal bone cyst of the mandible: case report and radiologic-pathologic correlation

A 33-year-old patient with a huge aneurysmal bone cyst (ABC) was imaged using cone-beam CT, MRI, and angiography. ABC is an uncommon non-neoplastic, expansile lesion of bone. Although common in the appendicular skeleton and spine, only 2% of the lesions occur in the craniofacial skeleton. The plain radiographic features of gnathic ABC may show an omni-expansile unilocular or multilocular radiolucency. Fluid-fluid levels have been reported in cystic compartments of ABCs; however, this feature is not diagnostically specific for ABC. In this article, we present a case of a rapidly growing, extraordinarily large ABC of the posterior mandible, with emphasis on comparative imaging features of this lesion in cone-beam CT, MRI, and carotid angiography.     

颌骨内神经鞘瘤11例临床分析

目的 回顾分析11例颌骨内神经鞘瘤的临床资料，旨在提高对疾病的诊断和治疗水平。方法 对1993年1月--2002年2月间经治的11例颌骨内神经鞘瘤患者，从临床、病理、免疫组化、影像学检查及治疗手段等方面进行回顾分析。8例良性者行彻底刮治加烧灼术；2例下颌骨恶性者行扩大切除加颈淋巴清扫术；1例上颌骨恶性伴神经纤维瘤病患者行上颌骨扩大切除加中厚皮片修复及颈淋巴清扫术，术后辅以放疗、化疗。结果 5例位上颌骨(1例恶性)，6例位下颌骨(2例恶性)；其X线表现有一定特异性，术后除1例上颌骨恶性者于11个月时死于广泛多发性转移外，其他10例随访7—122月无复发。结论 颌骨内神经鞘瘤临床上少见。CT、MRI及穿刺细胞学检查有助于该病的早期诊断；手术仍是最有效的治疗手段，预后一般良好；辅助放疗、化疗与否，尤其是伴发神经纤维瘤病患者无多大价值。     

颌骨內神经鞘瘤11例临床分析

目的回顾分析11例颌骨内神经鞘瘤的临床资料,旨在提高对疾病的诊断和治疗水平。方法对1993年1月～2002年2月间经治的11例颌骨内神经鞘瘤患者,从临床、病理、免疫组化、影像学检查及治疗手段等方面进行回顾分析。8例良性者行彻底刮治加烧灼术;2例下颌骨恶性者行扩大切除加颈淋巴清扫术;1例上颌骨恶性伴神经纤维瘤病患者行上颌骨扩大切除加中厚皮片修复及颈淋巴清扫术,术后辅以放疗、化疗。结果5例位上颌骨(1例恶性),6例位下颌骨(2例恶性);其X线表现有一定特异性,术后除1例上颌骨恶性者于11个月时死于广泛多发性转移外,其他10例随访7～122月无复发。结论颌骨内神经鞘瘤临床上少见。CT、MRI及穿刺细胞学检查有助于该病的早期诊断;手术仍是最有效的治疗手段,预后一般良好;辅助放疗、化疗与否,尤其是伴发神经纤维瘤病患者无多大价值。     

Extraosseous plasmacytoma of the Maxilla: CT and MRI findings

Plasmacytomas are a localized proliferation of plasma cells in the bone marrow and are less frequently seen in extraosseous organs or tissues. Extraosseous plasmacytoma is a rare malignant neoplasm and constitutes 3–5% of all plasma cell neoplasms. In this article, we describe a case of a patient with extraosseous plasmacytoma of the maxilla and the related computed tomography (CT) and magnetic resonance imaging (MRI) findings.     

Implant radiography and radiology

The practitioner placing dental implants has many options with respect to pre-implant radiographic assessment of the jaws. The advantages and disadvantages of the imaging modalities currently available for pre-implant imaging are discussed in some detail. Intra-oral and extra-oral radiographs are generally low dose but the information provided is limited as the images are not three-dimensional. Tomography is three-dimensional, but the image quality is highly variable. Computed tomography (CT) has been the gold standard for many years as the information provided is three-dimensional and generally very accurate. However, CT examinations are expensive and deliver a relatively high radiation dose to the patient. The latest imaging modality introduced is cone beam volumetric tomography (CBVT) and this technology is very promising with regard to pre-implant imaging. CBVT generally delivers a lower dose to the patient than CT and provides reasonably sharp images with three-dimensional information. A comparison between CT and CBVT is provided. Magnetic resonance imaging is showing some promise, but the examinations are not readily available, generally expensive and bone is not well imaged. Magnetic resonance imaging is excellent for demonstrating soft tissues and therefore may be of great use in identifying the inferior dental nerve and vessels. All of the above technology is of little value if the information required is not obtained and so information is also provided on imaging of some of the vital structures. Of particular interest is the inferior dental canal, incisive canals of the mandible, genial foramina and canals, maxillary sinus and the incisive canal and foramen of the maxilla.     

Peripheral epithelial odontogenic tumors: a review

Peripheral (extraosseous or soft tissue) odontogenic tumors are rare lesions that occur in the soft tissue overlying the tooth-bearing areas of the mandible and the maxilla. A review of the English-language literature revealed only 48 well-documented cases of peripheral epithelial odontogenic tumors. Thirty-two were peripheral ameloblastomas; six were peripheral adenomatoid odontogenic tumors; nine were peripheral calcifying epithelial odontogenic tumors; and one was a peripheral squamous odontogenic tumor. An additional four cases were reported as peripheral ameloblastomas in extragingival locations, but their odontogenic origin is debatable. Although the peripheral ameloblastoma is histologically similar to its central counterpart, it differs in its clinical features and biologic behavior. It does not exhibit an aggressive, destructive behavior and does not invade the underlying bone. Conservative excision of the tumor with minimal but adequate margins is the treatment of choice and recurrences are uncommon. This benign biologic behavior appears to be true also for lesions diagnosed as peripheral calcifying epithelial odontogenic tumors and undoubtedly is true for the peripheral adenomatoid odontogenic tumors.     

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.     

颞下颌关节髁突囊样变的多模态影像学分析

目的:分析颞下颌关节髁突囊样变的锥形束CT、螺旋CT、MRI及核素骨显像影像学特点,为其诊疗提供影像学依据。方法:回顾性纳入2018年1月至2020年12月就诊于解放军总医院口腔颌面外科,经锥形束CT影像检查发现髁突囊样变并进行螺旋CT、MRI检查和核素骨显像的患者32例,其中男性12例,女性20例,年龄（33.9±1...