PMC4246683_01
(A) Marginal facial asymmetry was observed on the left side of the patient's face. (B and C) Intraoral images were captured showing a large mass located in the buccal and palatal aspect of the edentulous alveolus of the left maxilla, in the area between the second premolar and the first molar. The mucosal surface was covered with rough hemorrhagic papules, which were pink-red in color.
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Extraoral examination revealed marginal left-sided facial asymmetry and tenderness (Fig. 1A); however, the patient experienced no abnormal sensation in the left buccal area. The intraoral examination revealed a mass, 25x35-mm in diameter, located in the buccal and palatal aspect of the edentulous alveolus of the left maxilla, in the area between the second premolar and the first molar (Fig. 1B and C).
A panoramic radiograph revealed a dome-shaped radiopaque mass with well-defined margins extending from the left maxilla to the maxillary sinus.
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The lesion caused the floor of the antrum to be elevated (Fig. 2).
Computed tomography images. (A) Axial soft tissue window images revealed a cystic lesion extending from the left maxillary alveolar area to the maxillary sinus. (B and C) Axial and coronal bone window images revealed the thickened floor of the antrum, which was elevated. (C) A section of the elevated sinus floor was destroyed.
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CT revealed a round cystic lesion, 30x40 mm in dimateter, which extended from the left maxillary alveolar region to the maxillary sinus (Fig. 3A and B). The floor of antrum was elevated by the cystic lesion and its margins were thickened (Fig. 3B and C). A section of the elevated sinus floor had been destroyed (Fig. 3C). 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) detected FDG uptake in the left maxilla [maximum standardized uptake value, (SUVmax), 12.4; Fig. 4A] and in two submandibular lymph nodes (SUVmax, 2.2).
(A) Axial 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography revealed FDG accumulation in the lesion in the left maxilla (maximum standardized uptake value, 12.2). (B) No other abnormal FDG accumulation was detected elsewhere by FDG-PET.
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A section of the elevated sinus floor had been destroyed (Fig. 3C). 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) detected FDG uptake in the left maxilla [maximum standardized uptake value, (SUVmax), 12.4; Fig. 4A] and in two submandibular lymph nodes (SUVmax, 2.2). No abnormal FDG uptake that would have been indicative of another primary tumor or distant metastasis was detected on the FDG-PET images (Fig. 4B).
Histopathological observations. (A) The tumor mass was located in the center of the maxilla and extended to the surface epithelium. The epithelium of the maxillary sinus was not involved. (B) The tumor cells formed atypical squamous epithelium, exhibiting features of squamous cell carcinoma (magnification, x2). (C) The surface of the mass was covered by non-cancerous oral mucosa with ulcers, indicating an intraosseous origin (magnification, x2).
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The histopathological examination of the excised specimen revealed tumor cells consisting of atypical squamous epithelial cells with enlarged nuclei, which had invaded the submucosal connective tissue and bone (Fig. 5A-C).