PMC5406800_01
Clinical photograph shows a diffuse solitary swelling on the left side of the face, involving the angle of mandible
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F1
A 27-year-old female patient presented with a history of swelling in mandibular left posterior region for 1 year and pain for 1 month [Figure 1].
(a) Orthopantomograph showing multilocular radiolucency in the mandibular body-ramus area on the left side. (b) Cone beam computed tomography image showing buccal expansion due to the lesion
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F2
The radiographic examination revealed a multilocular radiolucency involving left mandibular region [Figure 2a and b].
(a) Photomicrograph demonstrating follicles of ameloblastoma in mature fibrous stroma (H&E, x10). (b) Foreign body and associated granulomas (H&E, x10). (c) Multinucleated giant cells phagocytosing hyaline ring-like foreign particles (H&E, x40). (d) The foreign body demonstrating periodic acid-Schiff positivity (periodic acid-Schiff, x10)
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F3
Microscopic examination of the excised tissue specimen revealed follicles of ameloblastoma of varying sizes [Figure 3a]. The stroma was mature, collagenous and it demonstrated foreign body granulomas with numerous multinucleated giant cells [Figure 3b and c]. On careful examination, it was evident that these foreign body granulomas were associated with multiple, amorphous, eosinophilic masses enclosed in densely hyalinized eosinophilic matrix/rings [Figure 3b and c]. The hyaline rings were periodic acid-Schiff positive [Figure 3d].
(a) Foreign body showing peripheral smaller rectangular cells (demonstrated by arrowhead) and arrow pointing larger more angular cells in the center enclosing amorphous eosinophilic material (H&E, x40). (b) Processed pulse showing structure similar to the foreign body (H&E, x40)
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F4
We observed that a section of a legume [Figure 4b] bore a striking resemblance, to the foreign body we encountered.
(a and b) Photomicrographs showing the features of irregular foreign body particles in light microscopy and polarizing microscopy, respectively (H&E, x40). (c and d) Foreign body giant cells with ingested material which shows birefringence and hence is evident on polarizing microscopy (H&E, x40)
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F5
When viewed under polarized light, the hyaline structures exhibited birefringence [Figure 5a and b] and the fragments of material similar to hyaline rings were noted within the giant cells [Figure 5c and d].