PMC7395988_01
Orthopantomograph showing the presence of an ill-defined, mixed radiolucent-radiopaque lesion involving the #84 to #85 region. Bone and roots resorption can be observed (red arrow).
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The lamina dura, roots of #84 and #85, and furcation of #84 were resorbed (Figure 1).
CT images showing a lesion with bony cortex perforation (red arrow, (a) and (b)) and soft tissue infiltration and lymph nodes involvement (red arrow, (c) and (d)).
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The lingual cortex was partially damaged (Figure 2).
Photomicrographs showing sheets and nests of ameloblastic epithelium with inflammatory infiltration ((a) hematoxylin eosin); areas of tumor cells with hyperchromatism, nuclei pleomorphism, and some mitotic figures ((b) hematoxylin eosin); marked positive immunohistochemical expression of CK19 (c), Ki67 (d), and p53 (e).
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The peripheral cells of the nests resembled preameloblasts with cuboid shape and nuclei polarization (Figure 3(a)). Dedifferentiated areas exhibited cytologic malignant cells with increased nucleocytoplasmic ratio and hyperchromatic nuclei; few mitotic figures were present (Figure 3(b)). The ameloblastic epithelium showed a positive reactivity for CK19 (Figure 3(c)). High proliferation level of the neoplasm was confirmed by elevated expression of Ki67 and p53 (Figures 3(d) and 3(e)).
Photomicrographs showing tumor infiltration in the submandibular lymph node: dedifferentiated area with infiltrated neoplastic cells ((a) hematoxylin eosin); higher power view of the infiltrated lymph node showing nuclear pleomorphism and hyperchromatism of the neoplastic cells ((b) hematoxylin eosin).
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fig4
The positive submandibular lymph nodes were identified, and the microscopic examination of the lymph nodes showed diffuse infiltration of neoplastic cells (Figure 4).
Photographs of the patient at 2-year postoperation.
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Clinical and radiographic examination at 2 years postoperatively showed no sign of recurrence or metastasis (Figure 5).