Pathology Quiz Case 1

Abstract

A 29-YEAR-OLD WHITE WOMAN PRESENTED with pain and swelling of the left cheek that had begun a few months before. Thirteen years earlier, a surgeon in an outside hospital had enucleated a radicular cyst (apical inflammatory cyst) in the same area. The patient’s medical and family histories were noncontributory. A head and neck examination revealed no abnormalities other than the swelling of the left cheek, with mild fever and purulent drainage at the upper left posterior oral vestibule. Cortical perforation, along with pain and tenderness, was found during the intraoral palpation. All neighboring teeth were vital, and other dental abnormalities were absent. A panoramic film revealed a unilocular radiolucent lesion at the left maxillary tuberosity involving a root of the left upper second molar. However, the outline of the lesions was unclear because of overlapping of other structures, such as the maxillary sinus (Figure 1). The destruction of the left zygomaticomaxillary buttress and the cloudiness of the left maxillary antrum were noticed in a Water radiograph. Noncontrast computed tomography with a bone algorithm demonstrated a 2.3 2.8-cm spaceoccupying lesion in the left maxilla, extending from the tuberosity to the zygomatic arch and the orbital floor. The inflamed left maxillary sinus and oroantral communication were found in the area of the left upper third molar. It was impossible to differentiate benign sinus secretions from cystic mass on the computed tomograms (Figure 2 and Figure 3). The patient elected to undergo enucleation of the lesion via an intraoral vestibular approach with preservation of the maxillary walls, orbital floor, and zygomatic arch. Histologic examination of the hematoxylin-eosin–stained tissue demonstrated a cystic lesion lined by parakeratinized stratified squamous epithelium (Figure 4). What is your diagnosis?