PMC4598389_01
A panoramic view of the jaws shows a well-defined
unilocular radiolucency with central foci of calcification displacing
the roots of the maxillary canine and premolar.
TODENTJ-9-340_F1.jpg
PMC4598389_01_TODENTJ-9-340_F1.jpg
F1
Panoramic (Fig. 1) and occlusal radiographs (Fig. 2) showed an oval well-defined unilocular expansile radiolucency measuring 2 x 1.7 cm.
(A). Thick walled encapsulated lesion with intraluminal
epithelial proliferation and extracapsular fibrous tissue with irregular
mineralization (H&E- whole slide digital scan) (B). Multinodular
intraluminal solid and cribriform proliferation, CEOT-like areas
and extracapsular fibrous lesion with irregular mineralization (H&E
x 40).
TODENTJ-9-340_F3.jpg
PMC4598389_01_TODENTJ-9-340_F3.jpg
F3
A larger well-encapsulated lesion with a thick fibrous wall containing multinodular cellular proliferation with scanty connective tissue and multiple empty areas and, small fibrocellular proliferations interspersed with irregular mineralization partly attached to the extra-capsular surface (Fig. 3A & B).
(A). Intraluminal nodules consisting of cuboidal or columnar epithelial cells in the shape of nests, rosette-like patterns and duct- like
spaces with interlacing strands of oval, angular and elongated epithelial cells between nodules.Double layered basaloid epithelial cells in trabecular
or cribriform configurations between and connecting cell rich nodules. (H & E x 200) (B). Tumor droplets (Eosinophilic amorphous
material) between the cells and in Rosette-like structures (H&E x 400).
TODENTJ-9-340_F4.jpg
PMC4598389_01_TODENTJ-9-340_F4.jpg
F4
Basaloid epithelial cells formed single and double layered trabecular or cribriform configurations between and connecting cell rich nodules (Fig. 4A & B). The endothelial lining of the blood vessels showed degenerative changes (Fig. 4A).
CEOT -like area. (A). Island of polygonal epithelial cells with intracytoplasmic homogenous material and calcification (H& E x
400). (B). Polyhedral epithelial cells exhibiting intercellular bridges and calcification (H&E x 600).
TODENTJ-9-340_F5.jpg
PMC4598389_01_TODENTJ-9-340_F5.jpg
F5
Few areas showed collections of eosinophilic polyhedral squamous like epithelial cells with well-defined cell borders (Fig. 5A) and intercellular bridges (Fig. 5B). Calcified bodies were found through- out the lesion but were mostly associated with the polygonal cells (Fig. 5B).
Congo-red positive islands of amorphous eosinophilic (amyloid like) material (x 200). (A). Light microscopy, (B). Apple green birefringence
- partially crossed polarz, (C). Crossed polarz (x200).
TODENTJ-9-340_F6.jpg
PMC4598389_01_TODENTJ-9-340_F6.jpg
F6
Islands of amyloid- like material that were Congo-red positive and produced characteristic apple green birefringence on polarized microscopy were also found (Fig. 6A-C).
(A). Fibrocellular tissue interspersed with irregular trabeculae of bone and cementum-like tissue and foci of hemorrhage (H&E x 40). (B). Fibrocellular connective tissue interspersed with ginger root-like trabeculae showing few lacunae and ovoid cementicles with prominent
resting lines (H& E x 100).
TODENTJ-9-340_F7.jpg
PMC4598389_01_TODENTJ-9-340_F7.jpg
F7
Cellular areas showed spindle-shaped fibroblasts. (Fig. 7A & B).
Confluence of woven and lamellar bone in maturing trabecule, (A). H&E x 200. (B). Polarized light microscopy x 200.
TODENTJ-9-340_F8.jpg
PMC4598389_01_TODENTJ-9-340_F8.jpg
F8
The maturing areas of the lesion showed a confluence of woven and lamellar bone (Fig. 8A & B).