PMC7528028_01
Panoramic X-ray radiogram. Radiolucent lesions are seen in the right mandible (arrow). The high-density lesion is complicated by the periapical right mandibular 2nd molar. Additionally, mixed radiolucent/radiopaque lesion was shown in the left molar region (arrowheads).
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Mixed radiolucent/radiopaque lesion was shown in the left molar region (Figure 1).
CT images. (a, b) Well-defined, low-density lesions (arrows) with scalloped border, which accompanies a well-defined high-density appearance (arrowheads) are observed in the right mandibular molars on transverse and sagittal images. The left lesion shows mixed main low- (arrows) and partial high- (arrowheads) density areas with an unusual, marked irregular border in the molar region. The right lesion shows a unilocular, slightly irregular border. (c, d) Transverse CT images show high-density lesions in the right anterior and left posterior maxilla (arrowheads). CT: computed tomography.
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The right mandibular lesion showed a well-defined low-density lesion with scalloped border in the periapical areas of the right lower 1st molar, which accompanied a well-defined high-density lesion in the adjacent 2nd molar periapical area (Figures 2(a) and 2(b)). The left lesion presented mixed low/high-density lesion with an unusual, marked irregular border that was more irregular than the scalloped border in the molar region (Figures 2(a) and 2(b)). Additional high-density lesions were observed in the left 3rd molar and right lateral incisor areas of the maxilla, which were well-defined (Figures 2(c) and 2(d)).
Magnetic resonance images. (a) Transverse fat-suppressed T2-weighted images show extremely hyperintense signal areas in the bilateral mandible (arrows) and hyperintense signal areas in the right mandible and bilateral maxilla (arrowheads). (b) Contrast-enhanced T1-weighted images show thin, peripherally enhanced lesions in the bilateral mandible (arrows) and heterogeneously enhanced lesions in the right mandible and bilateral maxilla (arrowheads). (c) The ADC maps show extremely high ADC values (over 2.5 x 10-3 mm2/s) at cystic areas in the bilateral mandible. ADC: apparent diffusion coefficient.
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The MRI showed cyst-like extremely hyperintense signals on fat-suppressed T2-weighted images and thin peripheral enhancement on contrast-enhanced T1-weighted images at the right low-density areas (Figures 3(a) and 3(b)). Hyperintense signals on fat-suppressed T2-weighted image and heterogeneous enhancement on contrast-enhanced T1-weighted image were shown in the adjacent 2nd molar peripheral area of the right high-density lesion (Figures 3(a) and 3(b)). For left mandibular mixed low/high-density lesion on CT finding, MRI showed marked irregular cystic/fluid-collected lesion that was hyperintense signals on fat-suppressed T2-weighted image and thin peripheral enhancement on contrast-enhanced T1-weighted image (Figures 3(a) and 3(b)). Although no hyperintense signals were found on DW-MRI, ADC showed high values (over 2.5 x 10-3 mm2/s) at cystic areas in the bilateral mandible (Figure 3(c)).
Bone scintigram. Tracer accumulations are observed in the high-density lesion on CT finding of the mandible and maxilla.
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Compared to the CT findings, bone scintigram results showed high tracer uptake in the high-density lesions (Figure 4).
Histopathological findings (original magnification, x100). (a) Specimens of the high-density lesions comprised irregular piece of fibrous connective tissue adjacent to the woven bone trabecula, which had an osteoid rim-like border and prominent osteoblasts. Bar: 100 mum. (b) Specimens of the bilateral mandibular low-density lesions exhibited remnants of a partial bony cavity lined by slightly compressed connective tissue. Bar: 100 mum.
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The histopathological findings showed multiple irregular pieces of fibrous connective tissue adjacent to the woven bone trabeculae with an osteoid rim-like border and prominent osteoblasts (Figure 5(a)). There was no epithelium component in the tissue (Figure 5(b)).
Follow-up CT images. (a) Three months and (b) twenty-seven months after the incisional biopsy; the CT images indicate enlargement of the right and an anterior half area of the left low-density lesions. CT: computed tomography.
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The unilocular, slightly irregular border, low-density lesion of the right mandible, also enlarged with bone expansion (Figure 6).