PMC7273617_01
(a) Patient's panoramic radiograph: this radiograph was initially considered
non-suggestive of bone destruction in the right mandibular body and ramus. However, a
more careful observation would have revealed ill-defined radiolucency of the ascending
ramus of the mandible (right side), loss of lamina dura of the second right molar (#47)
and loss of the right mandibular canal wall, implying a possible malignancy. (b) CBCT
revealed an osteolytic lesion of the right mandibular retromolar area, extending to the
inferior alveolar canal and the tooth #46.
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Panoramic radiograph was taken, and the diagnosis of periodontal disease was made (Figure 1(a)). The patient was immediately referred to an oral and maxillofacial surgeon and underwent cone beam computed tomography (CBCT) that revealed an extensive osteolytic lesion of the right mandibular retromolar region (Figure 1(b)).
(a) Histopathological photomicrograph of the oral lesion illustrating lymphocytic
infiltration of the sub mucosal connective tissue. H and E stained section 250x. (b)
Higher power showing a monotonous population of numerous atypical lymphocytes with
hyperchromatic irregular nuclei with inconspicuous nucleoli. Isolated mitotic figures of
the tumor cells are also seen. H and E stained section 400x.
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Histopathological examination showed a diffuse proliferation of small-to-intermediate-sized lymphoid cells that infiltrated the sub-mucosal connective tissue stroma (Figure 2(a)). The tumor cells exhibited hyperchromatic nuclei, a high nuclear cytoplasmic ratio, and irregular nuclear contours, while mitotic figures were also seen (Figure 2(b)).