PMC8710718_01
Necrosis of the frontal region of the mandibular alveolar ridge and three missing incisors.
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F1
She presented with extensive necrosis of the frontal region of the mandibular alveolar ridge extending to deciduous molars and was missing three incisors (Figure 1).
Magnetic resonance imaging of the girl's mandible (T1 TSE fat sat contrast medium sequence) showed areas of bone necrosis (star) with peripheral reactive bone contrast enhancement (arrows) and enhancement of the soft tissue edema (arrowheads).
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F2
CT and MR imaging of the lower jaw showed diffusely altered bone with edema and necrosis of the mandibular corpus and the above alveolar ridge in the region extending from tooth 84 to tooth 74 (Figure 2).
Histopathology of the biopsy specimens taken from the lower jaw (first biopsy). (a) Inflamed gingival mucosa with superficial erosions, with granulation tissue and dystrophic calcifications. Retrospectively, calcifications were "reinterpreted" as remains of destructed alveolar bone. HE, original magnification, x4. (b) Recanalization of the small vessels in the inflamed gingival mucosa (mark). Note the intense mixed inflammatory infiltrate in the background and the swollen endothelial cells. HE, original magnification, x20.
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F3
Histopathologically (Figure 3a), biopsy of the mucosa of the lower jaw showed necrosis, granulation tissue, and changes compatible with epulis, corresponding partly to pyogenic granuloma and partly to peripheral ossifying fibroma. Necrosis and endothelial damage with individual mural thrombi and in some cases the appearance of recanalization of thrombotic changes along small vessels were seen (Figure 3b).
Histopathology of the skin efflorescence in the sacral area. (a) Focal epidermal necrosis is present in the center. Note the pronounced underlying small vessels with swollen endothelial cells in the papillary dermis. HE, original magnification, x6. (b) Electron microscopy of swollen endothelial cells obliterating the lumen of the aforementioned small veins.
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F4
Histopathologically, sacral focal necrosis of the epidermis and swelling of endothelial cells of the dermis were seen (Figure 4a). Swollen endothelial cells of small veins in the upper dermis that almost or completely close the lumen were confirmed by electronic microscopy (Figure 4b).