PMC3906659_01
38-year-old female patient with a huge swelling on the right side of the face diagnosed with calcifying epithelial odontogenic tumor. Front view shows the swelling extending from the right ramus (arrow black outline) crossing the midline up to the left parasymphysis region (solid black arrow) of the mandible.
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F1
On clinical examination, a huge, well-circumscribed swelling was seen on the right side of the face, ovoid in shape, extending from the right ramus crossing the midline up to the left parasymphysis region of the mandible, measuring 12 x 10 cm in greatest diameter, bony hard in consistency, and nontender on palpation [Figures 1, 2].
38-year-old female patient with a huge swelling on the right side of the face diagnosed with calcifying epithelial odontogenic tumor. Inferior profile view shows numerous tortuous veins (black arrows) owing to the stretching of the skin overlying the huge swelling.
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F2
On clinical examination, a huge, well-circumscribed swelling was seen on the right side of the face, ovoid in shape, extending from the right ramus crossing the midline up to the left parasymphysis region of the mandible, measuring 12 x 10 cm in greatest diameter, bony hard in consistency, and nontender on palpation [Figures 1, 2].
38-year-old female patient with a huge swelling on the right side of the face diagnosed with calcifying epithelial odontogenic tumor. Intraoral view reveals a swelling with bicortical expansion, obliterating the buccal sulcus, (arrow black outline) lobulations present lingually (solid black arrows) with displacement of mandibular and maxillary teeth (white arrows) on the right side.
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F3
Intraorally, a large swelling was seen extending from tooth 33 up to the right retromolar region with bicortical expansion, obliterating the right buccal sulcus, with lobulations present on the lingual aspect [Figure 3].
38-year-old female patient with a huge swelling on the right side of the face diagnosed with calcifying epithelial odontogenic tumor. Panoramic radiograph shows a single well-defined circular mixed radiopaque-radiolucent lesion on the right side of the mandible with displacement of the mandibular and maxillary teeth. Presence of a radiopaque mass in the center of the lesion (black arrow) with radiopaque streaks has the appearance of "driven snow".
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F4
There was the presence of a radiopaque mass in the center of the lesion, which could possibly be an impacted tooth or odontome with radiopaque streaks, which were suggestive of "driven snow" appearance [Figure 4].
38-year-old female patient with a huge swelling on the right side of the face diagnosed with calcifying epithelial odontogenic tumor. Axial view computed tomography scan shows a huge well-defined heterodense tumor mass on the right side of the mandible with the presence of a hyperdense irregular mass at the center of the lesion (black arrow).
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F5
Computed tomography (CT) images in axial, coronal, and sagittal planes [Figures 5-7] showed a large well-defined lytic soft tissue lesion measuring 12 x 10 cm in size having a predominantly calcified component in a snowflake pattern seen in the right mandible.
38-year-old female patient with a huge swelling on the right side of the face diagnosed with calcifying epithelial odontogenic tumor. Sagittal view computed tomography scan reveals a well-defined heterodense tumor mass with an irregular central hyperdense mass (black arrow) and expanded inferior border (white arrow) of the mandible without any perforation.
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F6
Computed tomography (CT) images in axial, coronal, and sagittal planes [Figures 5-7] showed a large well-defined lytic soft tissue lesion measuring 12 x 10 cm in size having a predominantly calcified component in a snowflake pattern seen in the right mandible.
38-year-old female patient with a huge swelling on the right side of the face diagnosed with calcifying epithelial odontogenic tumor. Coronal view computed tomography scan shows a well-defined heterodense tumor mass on the right mandible having a central irregular hyperdense mass (solid black arrow) with multiple irregular calcifications with a "snow flake" pattern (black outline arrows).
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F7
Computed tomography (CT) images in axial, coronal, and sagittal planes [Figures 5-7] showed a large well-defined lytic soft tissue lesion measuring 12 x 10 cm in size having a predominantly calcified component in a snowflake pattern seen in the right mandible.
38-year-old female patient with a huge swelling on the right side of the face diagnosed with calcifying epithelial odontogenic tumor. A multidimensional computed tomography reconstruction using a hard tissue algorithm exhibits the extent of the well-circumscribed giant tumor (white arrow).
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F8
The entire tumor mass was well-circumscribed with expansion of the cortices without perforation [Figures 8 and 9].
38-year-old female patient with a huge swelling on the right side of the face diagnosed with calcifying epithelial odontogenic tumor. A three-dimensional reconstructed profile image using a bone window exhibits the predominantly calcified well-defined tumor mass on the right side (white arrow) which has clearly spared the condyle (solid black arrow) and coronoid process (arrow black outline) on the affected side.
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F9
The entire tumor mass was well-circumscribed with expansion of the cortices without perforation [Figures 8 and 9].
38-year-old female patient with a huge swelling on the right side of the face diagnosed with calcifying epithelial odontogenic tumor. Hematoxylin and eosin stained biopsy section (x20) shows epithelial cells in sheets and islands dispersed throughout the connective tissue matrix along with numerous circular ring like calcifiactions (black arrows).
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F10
An incisional biopsy was done and histopathological evaluation revealed polygonal epithelial components in sheets and islands dispersed throughout the connective tissue matrix along with numerous circular ring-like calcifications [Figure 10].
38-year-old female patient with a huge swelling on the right side of the face diagnosed with calcifying epithelial odontogenic tumor. Hematoxylin and eosin-stained biopsy section shows polygonal squamous epithelial cells exhibiting distinct intercellular bridges (black arrow) along with cellular and nuclear polymorphism (white arrows), and areas of irregular calcification and eosinophilic material.
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F11
Occasional binucleated and trinucleated cells were seen [Figure 11].