PMC6784877_01
Preoperative Surgical Plan.. Preoperative surgical plan showing the swelling in the anterior area of the mandible, causing buccal and lingual bone expansion and displacement of the incisors.
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A nine-year-old female patient was reported to the Oral and Maxillofacial Surgery Department at the Faculty of Dentistry, Cairo University, complaining of a painless slowly growing swelling in the anterior area of the mandible of one year's duration, causing buccal and lingual bone expansion, displacement and looseness of the incisors ( Figure 1).
Gross examination of the incisional biopsy.. Gross examination of the incisional biopsy revealed two firm pieces of 2.5x2x1.2 cm in size; they were reddish white in color and solid in consistency.
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An incisional biopsy was performed, and gross examination revealed two firm pieces 2.5x2x1.2 cm in size, which were reddish white in color and solid in consistency ( Figure 2).
Photomicrograph of old incisional biopsy.. (
a) Photomicrograph of old incisional biopsy showing heavily scattered multinucleated giant cells (short arrow) in a background of highly cellular fibrous stroma consisting of mononuclear stromal cells (long arrow) and extravasated red blood cells (original magnification 40x). (
b) Newly formed bone trabeculae and osteoid tissue (star) were noted at the periphery of the lesion (original magnification 40x)
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Newly formed bone trabeculae and osteoid tissue were noted at the periphery of the lesion ( Figure 3).
Computed tomography (CT) of the lesion.. (
a) CT of the lesion showing a well-defined multilocular radiolucency with diffuse flecks of radiopacities, extending from the right impacted third molar area to the left first molar area. (
b) CT of the lesion showing perforations in the buccal and lingual cortical plates.
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It extended from the right impacted third molar area to the left first molar area causing perforations in the buccal and lingual cortical plates ( Figure 4).
Gross examination of the excised lesion.. Gross examination of the excised lesion showing numerous, reddish, hard and soft pieces of tissue that ranged in size, having the average of 2x2x1.5 cm.
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They were reddish in color, some were hard and others were soft in consistency ( Figure 5).
Photomicrograph of the excisional biopsy.. (
a) Photomicrograph of the excisional biopsy revealed extensive areas of cell-rich connective tissue stroma containing bands of osteoid matrix and anastomosing immature bone trabeculae (long arrows) (original magnification 40x). (
b) Scattered clusters of multinucleated giant cells (short arrows) (original magnification 40x). (
c) Plump osteoblasts can be seen surrounding the interconnecting immature bony trabeculae. Cellular osteoid (star) and some myxomatous areas (polygon) can also be detected (H&E stain, magnification 100x).
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However, other sections revealed extensive areas of cell-rich connective tissue stroma containing bands of osteoid matrix and anastomosing immature bone trabeculae surrounded by plump osteoblasts intermixed with scattered clusters of multinucleated giant cells ( Figure 6), features that are characteristic of juvenile trabecular ossifying fibroma.