PMC4555939_01
Preoperative photograph showing diffuse swelling of the lower one third of the Face
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F1
A 30-year-old male patient reported to the Oral and Maxillofacial Surgery Department with a complaint of swelling in left lower jaw since 1year [Figure 1].
(a-c) Orthopantomograph (OPG) (a) of lesion 7 years ago showing unilocular radiolucency with well-defined sclerotic border. (b) The radiograph of the lesion at the present time shows extensive involvement with the lesion having crossed the midline and involved the ramus right up to the sub-condylar region. Note the multilocularity. (c) Postoperative OPG showing stabilization of mandible with reconstruction plate and intermaxillary fixation
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F2
Records revealed an unilocular osteolytic lesion in the left mandible extending from the mandibular canine region to the second molar causing expansion of the jaw involving the lower border of the mandible [Figure 2a]. On radiographic examination, orthopantomograph (OPG) showed a large multilocular radiolucency with well-defined sclerotic borders with the expansion of the cortical plates [Figure 2b]. Postoperative OPG revealed adequate fixation and functional occlusion [Figure 2c].
Photograph showing submandibular approach to the mandible, mandibular resection and reconstruction plate placement
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F3
Segmental mandibulectomy was done under general anesthesia with the preservation of about 3 mm posterior border of the ramus and it was stabilized using 2.5 mm reconstruction plates [Figure 3].
Resected specimen showing the expansion of the buccal cortical plate
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F4
(a and b) Composite photomicrographs of H and E stained section showing the proliferation of spindles cells in fibrous stroma and psammoma bodies with osteoblastic rimming (c and d) showing blood filled spaces and multinucleated giant cells on the periphery of the blood vessels; features indicative of an aneurysmal bone cyst (H and E stained, magnification x10)
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F5
Numerous psammoma bodies having eosinophilic and fibroblastic rimming were distributed throughout the section [Figure 5a and b]. Pseudocysts of varying sizes filled with erythrocytes were seen, adjacent to which multinucleated giant cells were evident [Figure 5c and d].
(a-d) Composite photomicrographs of Picrosirius Red stained section (a) under the polarizing microscope showing fibrous stroma which has loose aggregations of connective tissue fibers and (b) the psammoma bodies with densely packed collagen (Picrosirius Red, original magnification x10). (c) H and E stained section showing spindles cells and psammoma bodies in fibrous stroma and (d) Immunohistochemistry with anti-osteonectin showing positivity for spindle shaped cells and negative for Psammoma bodies. (original magnification x 40)
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F6
Spindle cells in the stroma showed positivity whereas psammoma bodies were negatively stained [Figure 6a-d].