PMC8243122_01
Panoramic view illustrates a well-defined multilocular radiolucent lesion at
the right posterior area of the mandible.
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Some degree of apical root resorption is seen in both right first and second mandibular molars (Figure 1).
Axial (a) and coronal (b) CT scan images reveal mandibular expansion and
cortical bone perforation.
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In the axial and coronal computed tomography (CT) scan slices without contrast, a radiolucent lesion measuring 50 mm x 40 mm x 30 mm was seen in right mandibular angle with a homogenous density which caused mandibular expansion and cortical plates perforation (Figure 2(a) and (b)).
Gross examination of specimen revealing parts of the right mandibular body
and ramus demonstrating tan-gray intrabody mass with buccal cortical plate
perforation and 2.5 cm lobular protrusion.
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On gross examination, the specimen was consisting of a segment of the right posterior mandible from lower right first molar tooth to ascending ramus measuring 6.5 cm x 4.5 cm x 2 cm and 9 cm x 4.5 cm x 3 cm, respectively with a mass within the mandible bone measuring 9 cm x 4.5 cm x 3 cm which led to expansion, lateral mandibular cortex perforation and expansive deformity of the inferior alveolar canal (Figure 3).
Photomicrographic images of histologic sections: (a) H & E stained
section illustrating encapsulated spindle cell neoplasm with extensive
Xanthomatous degenerative changes (x40), (b and c) immunohistochemical
stained section with S100 protein showing diffuse strong nuclear and
cytoplasmic positivity of tumoral cells (b: x40, c: x100), and (d)
immunohistochemical stained section with Ki67 revealing around 2%-3%
proliferative activity in tumoral cells (x100).
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After multiple serial sectioning, more degenerative changes including sheets of hemorrhage and Xanthomatous cells were detected (Figure 4(a)-(c)). Immunohistochemical staining for Ki67 indicated 2%-3% positivity in tumoral cells (Figure 4(d)).
Frontal (a) and lateral (b) clinical view of the patient showing no
recurrence of lesion 4 years post-operation.
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Follow-up for 4 years duration declared no evidence of wound dehiscence, infection, or even recurrence (Figure 5(a) and (b)).