PMC4769240_01
Computerized tomogram findings. a The osteolytic lesion was localized in the left first and second molar area below the inferior alveolar canal. b The lingual cortex adjacent to the lesion showed erosive changes
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Fig1
From a computerized tomogram examination, we observed that the lesion was localized in the left first and second molar area below the inferior alveolar canal (Fig. 1a). The lingual cortex adjacent to the lesion showed an erosive change (Fig. 1b).
Intra-operative views. a The yellow colored semi-solid materials were filled with a bone marrow cavity. b After removing the osteolytic lesion, the surrounding cortical bone was thin but appeared intact
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Fig2
Yellow colored semi-solid materials were removed from the bone marrow cavity (Fig. 2a). The lesion was poorly encapsulated, and the surrounding cortical bone had become thin but appeared to be intact (Fig. 2b).
The hematoxylin and eosin staining view of the lesion. a Variable-sized woven bone was observed with a cholesterol cleft appearance under low magnification (bar 100 microm). b Under high magnification, the marrow stromal tissue was diffusely fibrosed and filled with fatty bubble-like materials, accompanied by the infiltration of many macrophages (bar 20 microm). c There also appeared to be several foci of the cholesterol slits (bar 50 microm). d The stromal fibrosis increased in the absence of vascular channels and advanced to the osteolytic trabecular bones, which showed irregular and rudimentary bony trabeculae with no signs of osteoid deposition (bar 50 microm)
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Fig3
Variable sized woven bone was observed with a cholesterol cleft appearance (Fig. 3a). The marrow stromal tissue was diffusely fibrosed and filled with fatty bubble-like materials and was infiltrated with a large number of macrophages (Fig. 3b). There also appeared to be several foci of the cholesterol slits, where fatty materials were also removed during the histological procedures (Fig. 3c). Stromal fibrosis increased in areas lacking vascular channels and advanced to the osteolytic trabecular bones, which showed irregular and rudimentary bony trabeculae with no signs of osteoid deposition and bisphosphonate-related multiple reversal lines (Fig. 3d).
An immunohistochemistry view of the lesion without counterstain. a Matrix metalloproteinase (MMP)-1. b MMP-2. c MMP-3. d Lysozyme. e Receptor activator of nuclear factor-kappaB ligand (RANKL). f Osteoprotegerin (OPG). g Hypoxia inducible protein alpha (HIFalpha). h Vascular endothelial growth factor (VEGF)
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Fig4
In the immunohistochemistry analysis, the marrow stromal tissue was weakly positive for MMPs and the infiltrated macrophages were strongly positive for lysozymes (Fig. 4).
Postoperative panoramic radiography. The bone healing was evident in the left mandibular notch area at 5 months postoperatively
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Fig5
The patient's symptoms disappeared during follow-up and bone healing was uneventful at 5 months postoperatively (Fig. 5).