PMC6243294_01
(a) Axial enhanced CT image in soft tissue window settings reveals a large right mandibular tumour consisting of a soft tissue component surrounding a markedly irregular and sclerotic mandibular ramus with some gas bubbles within the medullary cavity. The soft tissue component invades the masseter muscle (m) laterally and the pterygoid muscles (p) medially. The ipsilateral parapharyngeal space (blue arrow) and the Bichat's fat pad (red arrow) are medially and anteriorly displaced, respectively. (b-d) Axial and coronal CT images in bone window settings better depict the heterogeneous bone involvement with a more irregular and sclerotic pattern in the mandibular ramus occupying the central portion of the tumour (black arrows) and a more expansive, remodelling pattern in the angle and posterior body with a ground-glass pattern of bone-forming matrix. Different patterns of periosteal reaction are depicted lengthwise in the mandibular ramus, including a thick regular deposition resembling an "onion skin" (white arrow) and a ruptured Codman triangle (white arrowhead).
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fig1
Both neck CT (Figure 1) and MRI (Figure 2) were performed, showing a large, solid tumour arising from the ramus and posterior body of the right mandible.
(a, b) Synchronized axial T1 weighted and T2 weighted MR images show multiple coalescent hypointense foci in the region of the mandibular ramus (white arrow) and a surrounding soft tissue component isointense and hyperintense in relation to the remaining masseter (blue arrows) on T1 weighted image and T2 weighted image, respectively. (c) Axial enhanced fat-suppressed T1 weighted MR image demonstrates avid tumour enhancement and better depicts the involvement of the pterygoid space (asterisk). (d) Axial T1 weighted MR image at a lower level shows the replacement of the normal fatty marrow by an expansive soft tissue mass expanding and remodelling the cortical bone (red arrow).
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fig2
Both neck CT (Figure 1) and MRI (Figure 2) were performed, showing a large, solid tumour arising from the ramus and posterior body of the right mandible.
(a, b) Specimen from left hemimandibulectomy (haematoxylin and eosin stain, x4 and x20 magnification, respectively). Nests of neoplastic squamous cells (white arrow) may be seen infiltrating the trabecular bone (black arrow).
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fig3
The surgical specimen included a large, white and solid tumour with 11 x 7.5 x 6.5 cm, corresponding to an invasive, moderately differentiated (G2) SCC (Figure 3).