PMC3591079_01
Orthopantomogram of the patient; asterix indicates the extent and nature of the radioluceny in between the apices of the right maxillary canine and lateral incisor. Inset shows the periapical radiograph of the area
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F1
Routine panoramic examination revealed a radiolucent lesion in the right anterior region, measuring 1.7 cm x 1.4 cm [Figure 1]. Closer radiological examination with periapical radiography revealed that the maxillary right canine root was in juxtaposition with the entity while the lateral incisor had a loss of lamina dura [Figure 1].
The lesional area after raising the semilunar flap. Note the shape of the lesion and bone overlying the cyst
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F2
On elevating a wide, semilunar flap, a well-circumscribed area of elevated, thinned cortex was identified [Figure 2].
Total removal of the cystic content in toto
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F3
Carefully, the margins were explored and the entire lesion was removed in total after careful blunt dissection [Figure 3].
Composite image of A. The residual bone with healthy bleeding after removal of the cyst B. Buccal surface of the cyst C. Lingual surface of the lesion
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F4
The residual bone was clear with no evidence of cystic lining [Figure 4A]. The macroscopic appearance was nonspecific, except for the prominent superficial vasculature [Figure 4B and C].
A) The area showing thin OE with basal cells resembling ameloblasts, ghost cells, and extravasated red blood cells. (H and E section, 20x) B) A foci showing the thickened lining with palisaded basal cells resembling ameloblasts, ghost cells, and extravasated red blood cells. (H and E section, 10x) C) A foci showing thickened lining with palisaded basal cells resembling ameloblasts, ghost cells, superficial stellate reticulum-like cells, and extravasated red blood cells. (H and E section, 40x)
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F5
A few of them contained nuclear remnants [Figure 5].
A) Foci showing arrangement of solid areas of odontogenic cells near cystic lumen with cords and lattice pattern, indicative of AOT features (H and E section, 4x) B) Foci showing areas of cholesterol clefts in an uninfected area. C) Foci showing features suggestive of AOT. Note the ductal or rosette-like appearance, reversal of polarity, centrally placed atypical material that has varying pattern (asterix), prominent intercellular bridges, and duplicated basal membrane in certain areas. (H and E section, 20x)
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F6
Toward the center of the lesion, in this area, arrangement of ameloblast-like cells in the form of ductal or rosette pattern was observed [Figure 6]. Also in one particular foci, cholesterol clefts were identified [Figure 6B].