Cases reported "Mandibular Neoplasms"

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1/92. A unique case of desmoplastic ameloblastoma of the mandible: report of a case and brief review of the English language literature.

    A unique case of desmoplastic ameloblastoma is reported from the clinical, radiographic, and histologic viewpoints. The patient was a 56-year-old man who complained of a painless swelling on the buccal aspect of the left mandible. Periapical and panoramic radiographs revealed a rounded, slightly radiolucent area with blurred osteosclerotic margins. Occlusal radiograph and computed tomography images disclosed buccal bone expansion outlined by thinned cortices. Computed tomography images exhibited an enhanced area in the anterior portion of the lesion. Interestingly, the coronal computed tomography images revealed a close relationship between the periodontal membrane of the left mandibular second premolar and the enhanced area. biopsy specimens from the anterior portion of the lesion displayed typical histologic features of the desmoplastic variant of ameloblastoma. However, those from the posterior portion disclosed a large cystic formation. Oxytalan fibers were identified in the stromal tissue of the tumor, which suggested that the tumor arose from the epithelial rests of Malassez in the periodontal membrane of the related tooth. We also reviewed previously reported 41 cases. In 36 of 38 cases in which the location was specified, the tumor was found in the anterior to premolar region of the maxilla or mandible. A radiographic description was given in only 29 previous cases, 28 of which involved multilocular lesions. No cyst as large as the one in the present case was found among the previously reported desmoplastic ameloblastomas. Although the present case deviates from the usual desmoplastic variant of ameloblastoma in terms of locus, radiologic appearance, and cyst formation, it still meets the histologic criteria for this variant in both the stromal and epithelial components.
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2/92. Intraosseous neurofibroma of the jaws.

    Two cases of intraosseous neurofibromas of the mandible are presented. Only 25 cases of this tumor have been published previously. Of the present two cases, one was located at the upper border of the mandible, in the left second molar area where the tooth had been extracted 2 years previously. In the second case, the tumor presented itself as a 10 x 2 cm large destruction, mainly following the course of the alveolar nerve from the mandibular foramen to the mental foramen in the right side of the jaw. The mandibular first right molar was missing but the relationship between the extraction of the tooth and the development of the tumor could not be demonstrated. Histologically, the two tumors differed in the way that case 1 showed a conspicuous amount of delicate, wavy fibrils, some of which showed concentric lamellations resembling the pacinian corpuscle but without neurites containing nerve fiber bundles and also demonstrated a slight pleomorphism.
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3/92. Cemento-ossifying fibroma presenting as a mass of the parapharyngeal and masticator space.

    We report a case of cemento-ossifying fibroma that presented as a large extraosseous mass in the masticator and parapharyngeal space. CT scanning and MR imaging showed a large extraosseous mass with central conglomerated, well-matured ossified nodules and fatty marrow. The central matured ossified nodules were of low density on CT scans and high signal intensity on T1- and T2-weighted MR images. Multiplanar reformatted CT scans revealed the origin of the mass to be at the extraction site of the right lower second molar tooth.
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4/92. jaw and pulpal metastasis of an adrenal neuroblastoma.

    Hematogenous spread of malignant tumors to the dental pulp is very rare. A case of adrenal neuroblastoma in a 71/2-year-old boy which metastasized to the mandible and dental pulp is described. Tumor cells were found within the pulpal blood vessels of a deciduous molar tooth.
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5/92. Florid osseous dysplasia of the mandible: report of a case.

    In 1986, a 60-year-old African American woman visited the Marquette University School of dentistry with a complaint of a vague, dull pain in her lower left quadrant. Tooth No. 19 was extracted 10 years earlier because of extensive decay, and tooth No. 18 had received root canal therapy. A panoramic radiograph revealed the presence of ill-defined, multilocular, mixed (radiopaque-radiolucent) lesions present throughout the lower jaw. She was treated with antibiotics and scheduled for follow-up visits. When the symptoms persisted, tooth No. 18 was re-treated with root canal therapy and a representative biopsy was taken from the left mandibular area. The biopsy showed the presence of chronic osteomyelitis. The patient was treated with antibiotics and was scheduled for periodic check-up visits. In February 1995, she returned with the same symptoms in the left mandible. A panoramic radiograph showed persistence of the mixed radiopaque-radiolucent lesions throughout her mandible; however, the mass on the left side was more radiopaque and had assumed a "cotton wool" appearance. Tooth No. 18 was extracted and a biopsy was taken from the area. After correlating the clinical behavior, radiographic appearance, and histopathologic features, a diagnosis of florid osseous dysplasia with osteitis was made. This case represents a classic example of the difficulty in diagnosing fibro-osseous lesions using radiographic interpretation alone and the need to correlate the clinical, radiographic, and histopathologic features to reach a diagnosis. Additionally, the present case clearly shows treatment problems of an otherwise self-limiting condition when secondary involvement with osteomyelitis is also present. A brief description of the conditions that were included in the differential diagnosis and their management is presented.
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6/92. Primary non-Hodgkin's lymphoma of the mandible presenting following tooth extraction.

    A case of oral non-Hodgkin's lymphoma presenting following a tooth extraction is reported. The clinical presentation was that of a periodontal lesion and an extraction socket that failed to heal, which may have led to initial confusion in diagnosis and management.
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7/92. ameloblastoma--a diagnostic problem.

    A 50-year-old female was referred by her dental practitioner. She had a periapical radiolucency associated with the lower right second premolar tooth. The tooth was root treated and subsequently apicected. Tissue curetted at the time of surgery was shown to be a solid ameloblastoma which was managed initially by marginal excision. Histopathological examination of the resection specimen demonstrated tumour at the inferior margin. A segmental resection of the mandible with an immediate reconstruction using a free tissue transfer of the iliac crest was therefore performed. The case shows the need for vigilance in dealing with periapical pathology and underlines the importance of sending all tissue specimens for histopathological analysis.
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8/92. Juvenile ossifying fibroma of the mandible. An 8 year radiological follow-up.

    An 8-year follow-up of a juvenile ossifying fibroma in the left mandible of a 4-year-old boy is presented. The case demonstrated initial lack of radiological evidence of demarcation and subsequent eccentric enlargement, selective tooth displacement and a multilocular appearance in areas of active growth. An aneurysmal bone cyst and a decrease in the bone content was present in the excision specimen.
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9/92. Intra-alveolar granulocytic sarcoma developing after tooth extraction.

    Granulocytic sarcoma (GS) is a malignant tumour composed of poorly differentiated myeloid cells forming in an extramedullary site. It is generally associated with acute leukaemia, particularly the myelocytic type. Its appearance in patients with chronic myeloid leukaemia is exceptional. GS can appear in multiple locations with the oral cavity being rarely involved. A mandibular GS detected in a patient with chronic myeloid leukaemia 10 days after a tooth extraction is reported. The pathogenesis (by metastatic cells or migration through the Haversian canals) of the tumour is discussed.
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10/92. Odontogenic carcinoma occurring in a dentigerous cyst: case report and clinical management.

    This case report describes an unusual odontogenic carcinoma, which was detected during routine periodontal examination. The lesion occurred in a dentigerous cyst associated with an impacted third molar in an otherwise asymptomatic 66-year-old male patient. The impacted tooth and lesion were excised based on evidence of radiographic change and clinical findings. An unusual histopathologic presentation is reported. The treatment provided for this tumor and the management of impacted teeth is reviewed.
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