Ill-defined lytic mandibular lesion

Abstract

An otherwise healthy 69-year-old woman was referred to an oral medicine and facial pain clinic for evaluation of persistent right mandibular infection and pain that had begun 5 months previously. She correlated the onset to an extraction of the mandibular right first molar (tooth no. 30) due to gross caries. She had recurring episodes of facial swelling, tongue paresthesia, and dysgeusia. She reported that her symptoms did not improve despite multiple antibiotic treatments. Clinical examination revealed mobility and tenderness on palpation of the mandibular right anterior teeth and premolars. The rest of the clinical examination was otherwise unremarkable. Imaging studies, including periapical and panoramic radiographs and a cone-beam computed tomographic scan, showed ill-defined bone destruction around the mandibular incisors, right canine, and premolars (Figures 1 and 2). An incisional biopsy of the lesion was performed (Figures 3 and 4). Figure 2Axial computed tomographic image shows permeative bone destruction (arrows). View Large Image Figure Viewer Download Hi-res image Figure 3Hematoxylin-eosin stain (magnification ×600) shows a diffuse infiltrate of large lymphoid cells with large nuclei, vesicular chromatin pattern, and prominent nucleoli. Numerous atypical mitotic figures are also identified. View Large Image Figure Viewer Download Hi-res image Figure 4Photomicrograph (immunohistochemical stain, original magnification ×600) shows the cytoplasm of the atypical lymphocytes. There is diffuse cluster differentiation 20 immunoreactivity, indicating a B-cell lineage. View Large Image Figure Viewer Download Hi-res image Dr. Musbah is an assistant professor, Department of Oral Health Practice, Division of Oral Medicine, Diagnosis and Radiology, College of Dentistry, University of Kentucky, Lexington, KY. Dr. Omami is an assistant professor, Department of Oral Health Practice, Division of Oral Medicine, Diagnosis and Radiology, College of Dentistry, University of Kentucky, 800 Rose St, Room MN-320, Lexington, KY 40536-0297.