PMC6463812_01
Extraoral clinical appearance showing swelling of the right side of the maxilla (A); Intraoral appearance evidencing swelling in the posterior region of the right maxilla (B).
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Extraoral examination revealed discrete swelling, hard and fixed in the right side of the posterior region of the maxilla, causing facial asymmetry, with the absence of lymphadenopathy (Fig. 1A). The region was covered by normal oral mucosa (Fig. 1B).
Coronal (A) and axial (B) computed tomography images.
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The coronal computed tomography (CT) shows hypodense lesion extending from the second upper right premolar to the orbit base, with structures compatible with teeth in its interior and some hyperdensing points suggestive of calcification (Fig. 2A). In addition, opacification of the left maxillary sinus was observed (Fig. 2A and B). The axial CT image reveals similar characteristics previously described (Fig. 2B).
Trans-surgical operative aspect showing access to lesion (A); Surgical specimen of the lesion (B); Histopathological examination (hematoxilin-eosin stain, C-F): Islands and sheets of polyhedral cells, areas of extracellular and amyloid-like eosinophilic material, and small irregular foci of calcification (40x, C); Nests of polyhedral cells forming intercellular bridges and nuclear pleomorphism (100x, 200x, D-E, respectively); Epithelial cells with nuclear pleomorphism interspersed by homogeneous eosinophilic material and concentric calcifications (Liesegang rings) (200x, F).
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The surgical access revealed rupture of the vestibular cortical bone (Fig. 3A). On gross examination we observed two fragments of smooth tissue associated with teeth, measuring approximately 6.0 x 4.5 x 2.5 cm, which were sent for histopathological examination (Fig. 3B). Microscopically, the tumor was composed of islands and sheets of polyhedral cells forming intercellular bridges, areas of extracellular and amyloid-like eosinophilic material, small irregular foci of concentric calcifications (Liesegang rings) and cells with nuclear pleomorphism (Fig. 3C-F).