PMC8016570_01
Evidence of diffuse, proliferative soft tissue swelling in the region of the hard palate.
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fig1
On clinical examination, there was a diffuse, proliferative soft tissue growth of the maxilla extending from the marginal gingiva in the palatal aspect of the anterior tooth and involving the entire surface of the hard palate up to the level of the hard and soft palate junction along with erythema of attached gingiva in relation to posterior teeth palatally and buccally as well as Grade III mobility of all the anterior and posterior maxillary teeth (Figures 1 and 2).
Evidence of erythema of the attached gingiva in relation to maxillary posterior teeth. The clinical features resembled a periodontal pathology.
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fig2
On clinical examination, there was a diffuse, proliferative soft tissue growth of the maxilla extending from the marginal gingiva in the palatal aspect of the anterior tooth and involving the entire surface of the hard palate up to the level of the hard and soft palate junction along with erythema of attached gingiva in relation to posterior teeth palatally and buccally as well as Grade III mobility of all the anterior and posterior maxillary teeth (Figures 1 and 2).
Panoramic radiograph of the patient revealing evidence of interdental bone loss in relation to all the maxillary teeth.
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Coronal section of CBCT scan revealing destruction of walls of maxillary sinus along with involvement of nasopalatine canal.
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Based on CBCT and clinical findings, a preliminary diagnosis of intraosseous malignancy involving the palate was suspected (Figures 4-9).
Axial view of CBCT scan revealing moth-eaten appearance of maxilla involving the hard palate and maxillary bone.
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fig5
Based on CBCT and clinical findings, a preliminary diagnosis of intraosseous malignancy involving the palate was suspected (Figures 4-9).
3D reconstructed CBCT image revealing widespread destruction of maxilla and resorption of all maxillary teeth root apices.
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Based on CBCT and clinical findings, a preliminary diagnosis of intraosseous malignancy involving the palate was suspected (Figures 4-9).
Sagittal section of CBCT revealing destruction of hard palate.
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Based on CBCT and clinical findings, a preliminary diagnosis of intraosseous malignancy involving the palate was suspected (Figures 4-9).
Axial view of CBCT scan revealing involvement of anterior and middle ethmoidal air sinus on the right side.
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fig8
Based on CBCT and clinical findings, a preliminary diagnosis of intraosseous malignancy involving the palate was suspected (Figures 4-9).
Axial view of CBCT scan revealing narrowing and involvement of eustachian tube on the right side.
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fig9
Based on CBCT and clinical findings, a preliminary diagnosis of intraosseous malignancy involving the palate was suspected (Figures 4-9).
(a, b) Maxillectomy procedure done under local anesthesia.
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Before removal, thorough clinical examination of the specimen was done to determine the adequacy of the tumor (Figures 10(a) and 10(b) and 11(a) and 11(b)).
H and E section of tissue sample showing unencapsulated tumor close to surface epithelium with tumor cells arranged in solid nests.
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The tissue sample was sent for histopathological examination which revealed an unencapsulated tumor within the underlying connective tissue approximating the surface epithelium, with a varied pattern of arrangement of tumor cells that included solid nests, strands, ducts, and tubular and papillary patterns and was lined by 1-2 layers of oval/cuboidal cells along with a peripheral layer of flat cells suggestive of polymorphous low-grade adenocarcinoma of the palate (Figures 12, 13, and 14).
H and E sections showing ductal pattern of arrangement of tumor cells with evidence of vesicular nuclei.
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fig13
The tissue sample was sent for histopathological examination which revealed an unencapsulated tumor within the underlying connective tissue approximating the surface epithelium, with a varied pattern of arrangement of tumor cells that included solid nests, strands, ducts, and tubular and papillary patterns and was lined by 1-2 layers of oval/cuboidal cells along with a peripheral layer of flat cells suggestive of polymorphous low-grade adenocarcinoma of the palate (Figures 12, 13, and 14).
H and E sections showing arrangement of tumor cells in tubular pattern in the given tissue specimen.
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fig14
The tissue sample was sent for histopathological examination which revealed an unencapsulated tumor within the underlying connective tissue approximating the surface epithelium, with a varied pattern of arrangement of tumor cells that included solid nests, strands, ducts, and tubular and papillary patterns and was lined by 1-2 layers of oval/cuboidal cells along with a peripheral layer of flat cells suggestive of polymorphous low-grade adenocarcinoma of the palate (Figures 12, 13, and 14).