PMC3652139_01
(a) The first panoramic image shows an osteolytic area on the marginal bone border between 22 and 24. There is a deep vertical bone lesion on the mesial side of 24. It is challenging to see resorption on the coronal part of the roots. (b) Panoramic image three months after the extraction of 24. The healing of the extraction region is in progress. In the region 22-23, the osteolytic area has remained the same compared to the earlier image.
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fig1
A panoramic tomography showed a large resorption of the mesial side of the root of 24 (Figure 1(a)). An osteolytic area in the same region (teeth 22-23) was detected consistently with an image obtained three months earlier (Figure 1(b)).
(a) The root resorption is visible in the intraoral X-ray of 22-23. (b) CBCT axial slice above the marginal bone line. A 6 x 10 mm bone destruction, which is sharply lined, is visible in the region 22-23 on the palatinal side. The roots of the teeth 22-23 have resorption on the palatinal sides. (c) CBCT sagittal slice presenting the root of 22. On palatinal side of the root, there is a 2 x 4 mm deep resorption defect. Lesion on palatinal bone structure can also be seen. (d) CBCT sagittal slice of 23.
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Furthermore, cone beam tomography revealed a cystic, osteolytic area in the left palatal side of the roots from lateral incisor to first premolar in the left side (Figure 2).
(a) Hematoxylin-eosin staining showed dense aggregates of spindle cells in storiform architecture with scattered lymphocytes. (b) Immunohistochemical staining is strongly positive with smooth muscle actin and (c) with ALK (d) while Ki-67 positivity was low.
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Histopathological investigation revealed a compact cellular spindle cell proliferation with collagenous stroma with storiform architecture (Figure 3(a)). Mitotic activity was low as detected with Ki-67 level (Figure 3(d)). With immunohistochemistry (IHC), the tumor tissue was positive for smooth muscle actin (SMA), vimentin, and anaplastic lymphoma kinase (ALK) (Figures 3(b)-3(c)).