PMC8313314_01
(a) Extraoral swelling; (b) intraoral ulcerated mass with obliteration of labial vestibule; (c) radiographic presentation showing the expansion of cortical plates.
CRID2021-2093927.001.jpg
PMC8313314_01_CRID2021-2093927.001.jpg
fig1
Extraoral examination revealed that there was facial asymmetry (Figure 1) with the swelling extending from the right parasymphysis to the left parasymphysis region anterio-posteriorly and superio-inferiorly from the lower lip to the inferior border of the mandible. On intraoral examination, it is approximately 6 x 7 cm in size extending from 43 to 34 obliterating labial and lingual vestibules (Figure 1(b)). Orthopantamograph (OPG) revealed unilocular radiolucency extending from the mesial aspect of 43 to the mesial aspect of 34, and the occlusal view showed an expansion of labial and lingual plates with intact cortical bone (Figure 1(c)).
(a) H&E-stained section showing the cystic lumen lined by a thin nonkeratinized stratified squamous epithelium with columnar basal cells at focal areas (x100). (b) H&E-stained section showing epithelial proliferations into both the cystic lumen and the connective tissue wall (x40). (c) H&E-stained section showing odontogenic epithelial cells arranged in interconnecting strands and sheets with granular cells located centrally (x100). (d) H&E-stained section showing darkly stained polygonal cells arranged in sheets with homogenous eosinophilic deposits resembling CEOT-like areas.
CRID2021-2093927.002.jpg
PMC8313314_01_CRID2021-2093927.002.jpg
fig2
The H&E-stained sections of the excisional biopsy specimen revealed a well-defined cystic lumen lined by a nonkeratinized stratified squamous epithelium with basal tall columnar ameloblast-like cells and superficial stellate reticulum-like tissue satisfying Vickers and Gorlin criteria (Figure 2(a)). The epithelial lining showed mural proliferations and proliferations into the cystic lumen in the form of interconnecting strands and cords, with stellate reticulum-like tissue exhibiting granular cell differentiation with eosinophilic granules in the cytoplasm (Figures 2(b) and 2(c)). In some areas, eosinophilic polygonal cells with prominent nuclei and amorphous eosinophilic material resembling calcifying epithelial odontogenic tumor (CEOT) were noticed (Figure 2(d)).