Multiple Clinical Diagnostic Hypotheses for a Radiolucent Image in the Maxilla

Abstract

A 20-year-old man reported a cyst detected by his dentist. Intraoral examination revealed a hard and asymptomatic swelling in the right vestibular region of the maxilla between the canine and the second molar. Panoramic radiography showed a poorly defined multilocular radiolucent image, involving the right second premolar, with root resorption. Cone beam computed tomography showed expansion of the external cortical bone, with destruction of the floor of the maxillary sinus. The hypothetical diagnoses were central giant cell lesion, myxoma, odontogenic keratocyst, and aneurismatic bone cyst. Microscopically, dense fibrous connective tissue with nerve bundles was observed. Antibodies, such as S-100, neurofilament, enolase, AML/1A4, and CD117, rendered positive staining results. The microscopic diagnosis was intraosseous neurofibroma. Neurofibromatosis type I was discarded from consideration. The final diagnosis was solitary intraosseous neurofibroma of the maxilla. Surgical resection and curettage were performed. There was no recurrence after 6 months of follow-up.