PMC4555938_01
The lesion presented as painless palatal swelling (black arrow)
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F1
Clinical examination revealed an oval, non-tender, bony hard swelling on the left side of the hard palate, extending from the canine to second molar region [Figure 1].
(a-d) Three-dimensional radiographic evaluation of the lesion
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F2
A reformatted panoramic image [Figure 2a] from a cone beam computed tomography (CBCT) scan showed a large amorphous hyperdense mass in left maxillary molar region. However, the cross-sectional image at the level of maxillary first molar [Figure 2b] showed a well-defined, hyperdense mass originating from the palatal root that measured about 19 mm in greatest dimension. The tangential (parasagittal) section [Figure 2c] showed the lesion to extend from the distal of premolar to the second molar region, superimposing over the maxillary sinus. The axial section [Figure 2d] at the level apical to the furcation area of first molar showed the mass to be originating from the palatal roots and appeared to have breached the palatal cortex.
Excised lesion with involved teeth. The root of second molar was resorbed along the lateral aspect of the lesion (black arrow). The superior aspect of lesion showed thin bone and attached mucosa suggestive of the antral floor with its lining (inset with white arrow)
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F3
The excised specimen [Figure 3] was yellowish-white and roughly round in shape with a diameter of about 20 mm, had a granular texture and was attached to the palatal root of the first molar.
Photomicrograph of the lesion (a) showing cementoid tissue in fibrovascular stroma (H and E, x10). (b) Prominent reversal lines seen within sheets of cementum like tissue stroma (H and E, x40)
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F4
Histological examination of the decalcified surgical specimen revealed sheets of cementum like tissue with entrapped vascular connective tissue stroma [Figure 4a]. Prominent reversal lines were seen within the sheets of cementum-like tissue [Figure 4b].
(a) Clinical and (b-d) radiological pictures at 2-year follow-up showing normal healing process with no recurrence of the lesions
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F5
The patient has been under regular surveillance for 2 years and has not exhibited any sign of recurrence [Figure 5].