PMC3660158_01
Extraoral photograph showing diffuse swelling on left side of the mandible, with facial asymmetry
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figure1
Extra-oral examination showed an oval-shaped swelling on the facial aspect of the left mandible, with facial asymmetry (Figure 1).
Intraoral photograph showing obliteration of left buccal sulcus
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Intraoral soft tissue examination revealed obliteration in the left posterior vestibular region of mandible (Figure 2).
Panoramic radiograph showing multilocular radiolucent lesion in ascending ramus
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An orthopantomogram demonstrated a multilocular radiolucent lesion with sclerotic margin, which extended from the distal root of the lower left first molar to the sigmoid notch of the ascending ramus of the left mandible (Figure 3).
CT scan showing expansion and perforation of buccal and lingual cortical plates
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figure4
The computerized tomography (CT) scan also suggested expansion and thinning of both the buccal and lingual cortical plates (Figure 4).
Photomicrograph showing the transition of OKC into SCC (lumen (L), epithelial lining (E), keratin pearl (K), epithelial lining proliferating into connective tissue capsule (P), odontogenic islands (O), and inductive changes (I, inset))
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figure5
Histopathological examination with haematoxylin and eosin staining (Figures 5-7) showed a proliferating odontogenic epithelial lining with dysplastic features in the basal cell layer in the form of hyperchromatism, pleomorphism, basal cell hyperplasia, bizarre mitotic figures, and an altered nucleocytoplasmic ratio.
Odontogenic epithelium showing mural proliferation in the form of odontogenic islands. The inset shows the odontogenic islands at a higher magnification
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Histopathological examination with haematoxylin and eosin staining (Figures 5-7) showed a proliferating odontogenic epithelial lining with dysplastic features in the basal cell layer in the form of hyperchromatism, pleomorphism, basal cell hyperplasia, bizarre mitotic figures, and an altered nucleocytoplasmic ratio.
Photomicrograph showing features of malignancy: (A) odontogenic islands with mitotic figures, (B) dystrophic calcification, (C) areas of necrosis, and (D) angiogenesis associated with odontogenic islands
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Histopathological examination with haematoxylin and eosin staining (Figures 5-7) showed a proliferating odontogenic epithelial lining with dysplastic features in the basal cell layer in the form of hyperchromatism, pleomorphism, basal cell hyperplasia, bizarre mitotic figures, and an altered nucleocytoplasmic ratio.
Photomicrograph showing positive p53 staining in the invading odontogenic islands
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Immunohistochemical staining (Figure 8) helped to confirm the diagnosis, with the aggressive epithelial component stained intensely and diffusely positive with p53.