Maxillary Mass Research Articles

Atypical, non-secretory presentation of multiple myeloma in a dog

A 9-year-old, female-neutered West Highland White Terrier presented with a left forelimb lameness and maxillary oral mass. Radiography revealed a large, extensive aggressive bone lesion in the distal radius. CT...

十二指腸への遠隔転移を認めた上顎歯肉血管肉腫の1例

Angiosarcoma is a rare malignant tumor of endothelial cell origin that accounts for less than 0.1％ of all head and neck malignancies. Although angiosarcoma can occur in the head and neck region, the most common sites are the skin of the scalp and face. The occurrence of a primary angiosarcoma in the oral cavity is extremely rare. This report describes a case of angiosarcoma of the maxillary gingiva that metastasized to the duodenum.A 64-year-old Japanese man consulted our hospital because of a maxillary gingival mass. The lesion was a protruded multinodular mass with a maximum diameter of 1.5 cm and was localized to the gingival mucosa of the left side of the maxilla. On the basis of histological examination, the lesion was diagnosed as angiosarcoma, and the patient received partial maxillectomy under general anesthesia, including a 2.0-cm margin of normal tissue. Immunohistochemical examination revealed that the tumor cells were positive for CD31, CD34, and vimentin, and the Ki-67 index was up to 40％．Although local recurrence was not detected after the initial operation, distant metastasis to the duodenum appeared after 1 year 7 months. The patient and his family refused further treatment, and we therefore provided best supportive care. The patient died 2 years 1 month after the initial operation.

Cranial fasciitis presenting as a rapidly enlarging maxillary mass in a 2-year-old

Cranial fasciitis is an uncommon benign disorder characterized by a fibroblast-like cell proliferation, observed almost exclusively in children. Clinically, it manifests as a rapidly growing, solitary nodule in the head or neck area. Underlying bone involvement (cranial cortical erosion) is frequently detected. Histopathologic analysis allows differentiation between cranial fasciitis and fibrohistiocytic or even sarcomatous lesions observed in children. An increased awareness of the clinical and histopathologic characteristics of this entity seems important to establish the diagnosis, to adopt an adequate, conservative treatment and to avoid unnecessarily aggressive procedures. We report a rare case of cranial fasciitis presenting as a rapidly maxillary mass in 2 year old patient treated with surgical excision.

Computed Tomography Findings of an Unusual Maxillary Sinus Mass: Brown Tumor Due to Tertiary Hyperparathyroidism

Brown tumor is a non-neoplastic bone lesion that develops secondary to hyperparathyroidism and it is very rare in the maxillofacial region. We report the case of a 59-year-old man who presented with pain and a swelling in the left cheek. Computed tomography (CT) demonstrated an expansile and radioluscent lesion in the left maxillary sinus. Incisional biopsy was performed, and the diagnosis was Brown tumor. Brown tumor must be considered in the differential diagnosis of expansile lesions of maxillary sinus.

Maxillary odontogenic myxoma in young horses: Six cases (2003–2011)

SummarySix young horses presented with a rapidly expanding maxillary mass with concurrent nasal discharge. All horses had a nonpainful firm unilateral facial swelling centred over the maxillary sinuses, accompanied by mucopurulent nasal discharge. Diagnostic imaging revealed an infiltrative nasomaxillary mass with cheek tooth involvement, diagnosed as odontogenic myxoma. The tooth involvement included missing, malformed and/or displaced dental precursors or unerupted teeth. Due to the rapid expansion and extent of the masses, and the poor prognosis reported for surgical excision, euthanasia was recommended and performed in all cases. Macroscopically, a soft oedematous tissue with a grey to green colour was seen in the regions of missing, malformed or displaced dental precursors or unerupted teeth. Histologically, this tissue consisted of spindle shaped cells surrounded by an abundant homogenous pale stroma, rich in acid mucopolysaccharides. Immunohistochemistry was positive for actin and the mesenchymal marker vimentin. The cheek tooth involvement identified in the described cases resembled what is previously reported in odontogenic myxoma in children and young adults. Even in man, maxillary odontogenic myxoma represents a therapeutic challenge due to the invasiveness of the lesions and radical surgical excision is recommended. Treatment is further complicated by sinonasal involvement. Surgery was not attempted in the cases presented here due to the extent of the lesions and the risk of recurrence. Clinicians should be aware of this rare condition when presented with young horses with sinonasal neoplasia.

Panostotic Expansile Bone Disease With Massive Jaw Tumor Formation and a Novel Mutation in the Signal Peptide of RANK

Precise regulation of bone resorption is critical for skeletal homeostasis. We report a 32-year-old man with a panostotic expansile bone disease and a massive hemorrhagic mandibular tumor. Originally from Mexico, he was deaf at birth and became bow-legged during childhood. There was no family history of skeletal disease. Puberty occurred normally, but during adolescence he experienced difficulty straightening his limbs, sustained multiple fractures, and developed a bony tumor on his chin. By age 18 years, all limbs were misshapen. The mandibular mass grew and protruded from the oral cavity, extending to the level of the lower ribs. Other bony defects included a similar maxillary mass and serpentine limbs. Upon referral at age 27 years, biochemical studies showed serum alkaline phosphatase of 1760 U/L (Nl: 29-111) and other elevated bone turnover markers. Radiography of the limbs showed medullary expansion and cortical thinning with severe bowing. Although the jaw tumors were initially deemed inoperable, mandibular mass excision and staged partial maxillectomy were eventually performed. Tumor histopathology showed curvilinear trabeculae of woven bone on a background of hypocellular fibrous tissue. Fibrous dysplasia of bone was suspected, but there was no mutation in codon 201 of GNAS in samples from blood or tumor. His clinical and radiographic findings, elevated serum markers, and disorganized bone morphology suggested amplified receptor activator of NF-κB (RANK) signaling, even though his disorder differed from conditions with known constitutive activation of RANK signaling (eg, familial expansile osteolysis). We found a unique 12-base pair duplication in the signal peptide of TNFRSF11A, the gene that encodes RANK. No exon or splice site mutations were found in the genes encoding RANK ligand or osteoprotegerin. Alendronate followed by pamidronate therapies substantially decreased his serum alkaline phosphatase activity. This unique patient expands the phenotypes and genetic basis of the mendelian disorders of RANK signaling activation.

Solitary Labial Metastasis of Adrenocortical Carcinoma Resembling a Cystic Tumor in a Child

Solitary Labial Metastasis of Adrenocortical Carcinoma Resembling a Cystic Tumor in a Child

Immunoglobulin G4-related disease presenting as an ethmoid and maxillary mass

Immunoglobulin G4-related disease presenting as an ethmoid and maxillary mass

Comparison of Standard Radiography and Computed Tomography in 21 Dogs with Maxillary Masses

Imaging of patients with oral cancer is required to determine tumor extension in order to assist in prognosis and surgical planning. Conventional screen-film radiography (SFR) used to be the most common method for oral assessment, but computed tomography (CT) has become more available and is being used for obtaining complementary information. CT examinations eliminate superimposition by acquiring cross-sectional images of the region of interest. The objective of this study was to determine the diagnostic value of SFR compared with CT examinations for evaluation of oral masses in dogs. Twenty-one dogs received head and thorax SFR, and pre- and post-contrast head CT. Bony changes were observed in 80.9% and 95.2% of the cases in SFR and CT studies, respectively. Invasion of adjacent structures (i.e. nasal cavity, frontal and sphenoidal sinuses, orbit, maxillary recess, nasopharynx) was observed in only 30% of cases with SFR while CT showed 90.4% involvement. CT is an important preoperative examination modality and is more effective in identifying bone changes and tumor invasion of adjacent structures compared with SFR.

The anatomical evaluation of the dental arches using cone beam computed tomography - an investigation of the availability of bone for placement of mini-screws

ObjectiveTo assess the amount of maxillary and mandibular inter-radicular bone mass and determine the most reliable mini-screw placement sites.Materials and methodsRetrospective Cone Beam Computed Tomography (CBCT) images of 40 Angle Class I subjects (20 females, 20 males, aged 16 to 32) were obtained. Measurements on the buccal (BI), medial (MI) and lingual (LI) sides of the inter-radicular spaces were taken at 0, 1, 2, 3, 4, 5 mm from the cemento-enamel junction (CEJ) in an apical direction.ResultsThe male and female BI scores ranged from 2.99±0.73 mm to 6.18±1.03 mm and 2.69±0.84 mm to 6.21±1.22 mm respectively. The male and female MI scores ranged from 1.36±0.38 mm to 4.50±0.99 and 1.53±0.66 to 4.77±1.99 mm respectively. LI scores ranged from 2.37±0.70 to 6.47±1.0 mm and 2.45±0.56 mm and 6.66±1.33 mm respectively. In both maxillary and mandibular arch, the inter-radicular space increased in the apical direction except for the buccal and medial inter-radicular spaces between the maxillary first and second molars.ConclusionThe medial inter-radicular spaces are the decisive parameter for mini-screw placement. In the maxillary arch, regions between central and lateral incisors, lateral incisor and canine, first and second molars are not viable for mini-screw insertion. The residual inter-radicular regions are proper for implantation at 3 mm above the CEJ. In the mandible, the regions between incisors and canines are too narrow for mini-screw insertion and the reliable sites for mini-screws are regions between premolars, molars or first molar and second premolar at 2 mm below the CEJ.

English

Extramedullary plasmacytoma is a rare malignant plasma cell tumor. We report two extremely rare cases of extramedullary plasmacytoma, one of the maxillary sinus and the other of the nasal cavity. A 57 yr old man presented with swelling of right maxilla and hard palate. CT scan revealed right maxillary mass with inferior and lateral extension. Another 63 yr old woman presented with mass in left nostril with a huge swelling to the left of nose. Histopathology examination of both the masses revealed abundant plasma cells and diagnosed as extramedullary plasmacytoma. Both patients were planned for radiotherapy. INTRODUCTION: Extramedullary plasmacytoma is a localized collection of monoclonal plasma cells in an extra skeletal site. Extramedullary plasmacytoma (EMP) represents approximately 3% of all plasma cell neoplasms and < 1% of all head and neck tumors (1). The tumours arise predominantly in the sub mucosal tissues of the nasal cavity, paranasal sinus, nasopharynx, oropharynx and larynx. The nasal cavity and nasal septum are probably the most common locations.(2) The incidence in males is three times that of females. The most affected age group is 50–70 years. It is usually solitary or localized, but 10% of the patient have multiple site involvement.(3) We present two cases of extramedullary plasmacytoma. One of the right maxillary sinus and the other of the left nasal cavity.

Colliding Tumor of the Paranasal Sinus

Sinonasal malignant neoplasms comprise only 3% of all head and neck malignancies. Synchronous and metachronous tumors of the head and neck have been described, but rarely have there been reports of a single tumor with two distinct histologies. Here, we describe a case of a sinonasal malignant neoplasm with two distinct histologies. A case report and literature review was performed. We present a case of paranasal sinus neoplasm involving two malignant cell types. An 83-year-old woman presented with a 2-year history of symptoms suggestive of chronic sinusitis, which included nasal congestion and intermittent midface pressure. More recently, her symptoms progressed with the development of left-side epistaxis and she was found to have a mass in the left maxillary and ethmoid regions. A biopsy of the maxillary sinus mass revealed a moderately differentiated squamous cell carcinoma (SCC). She underwent complete resection of the lesion through an extended endoscopic approach. Final pathological analysis showed a malignant neoplasm with two distinct malignant morphologies; a moderately differentiated SCC and small cell neuroendocrine carcinoma. Appropriate diagnosis and treatment of head and neck malignancy depends on accurate tumor classification and staging. We present a case of a sinonasal tumor with two distinct malignant entities and review the available literature on the subject. Additionally, we discuss the etiologic theories and challenges in planning the optimal approach to management in this scenario.

Effects of premolar extractions on Bolton overall ratios and tooth-size discrepancies in a north Indian population

Aim:The purpose of this study was to evaluate the Bolton overall ratio in a north Indian population reporting for orthodontic treatment and to determine the effect of extractions on the Bolton ratios. Another aim of the study was to check the effects of different extraction patterns on the final Bolton ratio.Materials and Methods:One hundred and twenty pre-treatment dental casts (60 males and 60 females) of orthodontic patients were selected randomly. Mesio-distal dimensions of the mandibular and maxillary teeth were measured before treatment, and subjected to Bolton analysis. Hypothetical tooth extraction by the following combinations: All the first premolars, all the second premolars, upper first and lower second premolars and upper second and lower first premolars were performed for each patient. The measurement results were again subjected to Bolton analysis to see whether any tooth-size discrepancy had been created.Results and Conclusion:The tooth material ratio of the studied north Indian population shows a mild maxillary tooth material excess. Extraction of premolars in any combination causes the maxillary tooth material to further increase. There is no significant sex difference in the tooth material ratios with or without extractions. In patients requiring extraction; all first premolar extraction or maxillary first and mandibular second premolar extraction should be preferred. For deciding a treatment plan involving extraction of teeth, we need to consider that the maxillary tooth mass may increase after extraction. Furthermore, the normal or the clinically significant tooth size discrepancies may change following extraction of teeth.

Metastatic hepatocellular carcinoma presenting as a maxillary sinus mass; a fine needle aspiration cytology diagnosis

Metastatic hepatocellular carcinoma presenting as a maxillary sinus mass; a fine needle aspiration cytology diagnosis

Plexiform ameloblastoma of the maxilla with extension to sinonasal cavity: Presenting with loosening of teeth

Ameloblastomas are locally aggressive jaw tumors with a high propensity for recurrence that are believed to arise from remnants of odontogenic epithelium, lining of odontogenic cysts, and the basal layer of the overlying oral mucosa. The unusual presenting symptoms, as well as the highly destructive nature of these lesions when arising in the maxilla, make them worthy of consideration in the differential diagnosis of nasal and maxillary masses. We present a rare case of right maxillary ameloblastoma in a 48 year old male patient who presented with the main complaint of loosening of molar teeth. History also revealed unilateral nasal obstruction of long duration about which the patient was least concerned. The computed tomography scan revealed a soft tissue polypoidal mass in the right maxillary sinus involving alveolar arch of the maxilla, with expansion of sinus and erosion of posterolateral wall. Initial biopsy confirmed ameloblastoma, which was followed by excision of the tumor by radical surgery. The case represents an unusual presentation of a rare odontogenic tumor.

Myxoid Type of Malignant Fibrous Histiocytoma of the Maxillary Sinus: A Case Report

Introduction: Myxofibrosarcoma was originally described as the myxoid variant of Malignant Fibrous Histiocytoma (MFH), a high-grade and aggressive sarcoma, which is very uncommon in the head and neck region, with about 100 cases reported up to now. MFH occurring in the maxillary sinus is so rare that only 23 cases have been reported. We hereby report a case of myxofibrosarcoma in the maxillary sinus. Case Report: The case was a 54-year-old male with symptoms of toothache in the right posterior maxillary teeth, a swelling adjacent to maxillary molar region and symptoms of chronic maxillary sinusitis. In clinical examination, the teeth were sensitive to percussion and palpation, but no caries and restoration was detected on his molar teeth. He was suffering from local pain and tenderness over his midface and mild fever, fatigue and some nonspecific vague pain. CT scan showed a mass lesion involving right nasal cavity, maxillary and ethmoidal sinuses. A lowgrade malignancy arising from the right maxillary sinus was highly suspected. A surgery was done to remove the mass. The histological and immunohistochemical studies proved the diagnosis of myxoid variant of Malignant Fibrous Histiocytoma. Therefore radiotherapy and chemotherapy was started for the patient but six months later the symptoms returned and CT scan showed a right maxillary and ethmoidal mass that extended to base of the skull. Maxillectomy and ethmoidectomy were performed for the patient, but 2 months later he died because of the extension of the tumor, which confirmed the necessity of early diagnosis. Conclusion: Amplified radical surgery is the first choice of treatment. The second surgery has special value to the recurrent patients. Radiotherapy alone or chemotherapy alone is not effective to MFH of head and neck region

Mesenchymal Chondrosarcoma of maxilla: A rare case report

Mesenchymal chondrosarcoma (MC) is a rare variant of chondrosarcoma (CS) that accounts for upto 3-9% of all CS and has high predilection for the head and neck region. It is usually seen in younger age group compared to conventional CS and maxillary anterior alveolus is the most common site. The tumor is most unusual as it has been described as a particularly aggressive neoplasm with a high tendency for late recurrence and delayed metastasis. It is a biphasic tumor with areas comprising of spindle cell mesenchyme interspread with areas of chondroid differentiation. A 75 year old male presented to us as a painless mass in maxilla. Contrast enhanced computed tomography (CECT) revealed a lytic expansile lesion in the left maxillary bone with foci of calcification within soft tissue lesion. Fine needle aspiration cytology (FNAC) and incisional biopsy was performed which confirmed the diagnosis of maxillary MC. The patient underwent right and left subtotal maxillectomy with 2 cm margins. The review of literature shows that very few cases of maxillary MC have been reported so far. Thus an attempt is made to add this rare case of MC of maxillary alveolus in the English literature.

Two Cases of Maxillary Sinus Hematocele Mimicking Malignant Tumors

We report 2 cases of relatively rare hematocele of the maxillary sinus in 14-year-old and 38-year-old men reporting nasal obstruction and epistaxis. Computed tomography (CT) showed isodensity maxillary sinus masses mimicking malignant tumors by destroying the bony wall. Masses were removed transmaxillarily and endonasally. Both were diagnosed histopathologically as hematocele.

Maxillo-facial Extraskeletal Myxoid Chondrosarcoma: A Case Report and Discussion

In this report, we share our experience of a case of maxillo-facial extraskeletal myxoid chondrosarcoma, a very rare location for this neoplasm. In addition, a literature review is provided. The patient, a 61-year-old male, had a maxillary mass encroaching on the nasal cavity. After debulking, the tumor recurred, attaining its pre-surgical proportion in two months. The patient improved clinically with radiation and remained stable for about one year. However, he ultimately developed metastases in his lung which were treated with palliative chemotherapy with a good outcome lasting three months. We could find only eight reported cases of this tumor in the head region of which two are in the maxilla; hence, ruling out other primary sites is mandatory for a patient presenting with a primary head and neck mass. Surgical removal may be complicated because of the location. A combination of surgery and radiation is the management of choice, with palliative chemotherapy in metastasis.

Maxillary Ameloblastic Fibroma in a Dog

A 4-year-old spayed female Golden Retriever was presented for evaluation of a rostral maxillary gingival mass. An en bloc resection was performed after histologic diagnosis of ameloblastic fibroma from an incisional biopsy specimen. Histologically, the tumor was composed of (1) poorly differentiated vimentin-positive mesenchymal cells that surrounded islands and (2) thin anastomosing trabeculae of odontogenic epithelium that variably coexpressed pancytokeratin and vimentin. To the authors' knowledge, this is the first report of ameloblastic fibroma in a dog. The clinical, radiographic, and histologic findings in this case are compared to those in other domestic animals and humans.