PMC3725788_01
Case  1:resection specimen of the mandible. The probe reveals the loss of clinical attachment within the periodontal space, and the tumor seems to emerge from the periodontal compartment.
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fig1
The expansion of the tumor reached from the sulcus glossoalveolaris with its center along the alveolar crest to the adjacent buccal mucosa (Figure 1). The patient reported herself to be a never smoker and never ingested alcohol. The clinical appearance (Figure 1) showed an exophytic mass with contact to the distal root of 36.
Case  1:the preoperative OPTG exhibits severe horizontal and vertical bone loss of the jaws. In addition, peri- and interradicular osteolytic lesions around tooth 36 are present. A soft radiopacity as projection of the tumor mass can be identified along the intact alveolar crest distal of 36. Radiolucency, suspect for bone invasion is solely present at the interradicular and distal aspect of the roots.
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fig2
The preoperatively taken orthopantomography (OPTG) revealed a considerable generalized horizontal type of bone loss within the upper and the lower jaw, as also a distinct inter- and periradicular osteolytic lesion at the region of 36 (Figure 2).
Case  1:cross section specimen. The black arrow highlights the close relation of the distal root to the tumor mass (*) with preserved cortical bone distal to the tooth. The white arrow points at a tumor formation along the mesial root filling out the interradicular space.
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fig3
The cross-section specimen (Figure 3) furthermore highlights the interradicular spreading of the tumor without an infiltration of cancellous bone or the distal alveolar crest.
PMC3725788_02
Case  2:the clinical aspect consists of a fibrin-coated ulcer in region of the wisdom tooth at the left lower mandible. The adjacent mucosa shows perifocal signs of inflammation (*).
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fig4
The ulcer was delineated by a rigid wall of mucosa attached to the alveolar crest related to 37 and 38 (Figure 4).
Case  2:Preoperative OPTG:A large formation of enhanced translucency is found in projection of the radices 36 and 37 as also at the pericoronal aspect of the partially retained wisdom tooth.
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fig5
The preoperatively taken OPTG (Figure 5) revealed considerable periradicular bone loss in regions 37 and 36 analogous to typical radiologic findings in patients with moderate to advanced chronic periodontitis.
Case  2:cross section specimen with a sectional view from distal after removal of the bony aspect that contained the wisdom tooth. The tumor is in broad contact to the periodontium (arrow) with infiltration of the adjacent cancellous bone and the floor of the mouth.
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fig6
The patient underwent radical intended resection of the tumor.  Figure 6 shows the resection specimen from a distal view.
Case  2:histological view of the cross section specimen after Haematoxglin-Eosin staining. The arrows mark the arrosion of the bone (*) by the tumor cells.
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fig7
The beginning infiltration of the mouth floor becomes apparent.  Figure 7 shows the microscopic view with arrosion of the bone by the tumor cells.
PMC3725788_03
Case  3:clinical situation. A partially ulcerous tumour formation covered the lingual aspect of the alveolar crest adjacent to the two distal molars (46 and 47). Nearly all teeth of this quadrant show clearly the sequelae of nearly nonexistent oral hygiene habits. Striae of leukoplakia are found on the wall of the ulcer, the tongue, and also along the vestibular papillae.
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fig8
Around the ulcer, fields of homogeneous leukoplakia were detectable (Figure 8).
Case  3:preoperative OPTG. Beside multiple carious lesions the present X-ray examination reveals signs of chronic periodontal disease with a general loss of horizontal bone level, liberation of both dental roots, and bifurcations. The local maximum of destruction is found in the region of the last two molars. The retromolar triangle, however, appears to be intact.
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fig9
The OPTG (Figure 9) exhibited severe general bone loss with a basin-like translucency comprising the last distal molars of the right mandible.
Case  3:the sagittal split preparation of the resection specimen from a lingual view clearly shows the association of the tumor (borders marked with lines) to the dental alveoli ( ) of the distal molars. The teeth 36 and 37 are lost due to the preparation process.
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fig10
A radical intended operation followed.  Figure 10 shows a transverse section of the resected mandible from a lingual view.
PMC3725788_04
Case  4:a superficial ulcerous lesion atop of a mass at the left sublingual space with extension to the lingual aspect of the alveolar crest comprising the teeth 31 to 34 and surrounding leukoplakia.
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fig11
The patient noticed an indolent growing mass five weeks before admission.  Figure 11 gives a picture of the clinical situation.
Case  4:preoperative OPTG. A general horizontal loss of bone in both jaws with additional vertical translucencies in the front aspect of the mandible and signs of erosion of the alveolar crest at the left lower quadrant.
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fig12
The OPTG (Figure 12) revealed a generalized horizontal type of bone loss within both jaws, with additional vertical bony defects and translucency as radiologic finding for an erosive process in the left anterior lower jaw.
Case  4:the split resection specimen from a lingual view demonstrates the association of tumor formation along the root of the left lower canine (white arrows) as also further invasion of the cancellous bone.
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fig13
The split-resection specimen (Figure 13) shows a periradicular tumor formation along the root of the canine with infiltration of the neighboring cancellous bone.
Case  4:histological view of the tumor after immune-histochemical staining against p16. The brown signal (*) proves the infection with HPV.
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fig14
HPV status by p16 immunostaining was positive, as shown in Figure 14.