Mixed Radiolucent-radiopaque Lesion Research Articles

HAMARTOMATOUS GROWTH IN A CHILD, AMELOBLASTIC FIBRO-ODONTOME: A CASE REPORT

Introduction: Ameloblastic fibro-odontoma is a rare, mixed, benign, odontogenic tumor with significant prevalence in the mandible. It is characterized by histologic features of ameloblastic fibroma with the formation of enamel and dentine. It usually affects pediatric patients and is associated with teeth, leading to delay in eruption or a deviation in the dental eruption pathway. This is a case report of Ameloblastic fibro-odontoma and its management in a 11 y Case Report: ear old boy. Intra-oral examination revealed an edema in the buccal area of the mandible's posterior right region. Radiographic examination showed an expansile, mixed radiolucent-radiopaque lesion with well-defined corticated border. Surgical enucleation and curettage was performed under general anesthesia. Histopathologic findings led to diagnosis of Ameloblastic fibro-odontoma. Although Ameloblastic fibro-odontoma is a rare tumor, its Conclusion: prevalence is more in children’s jaw. Conservative surgical treatment allowed the normal development with no sign of recurrence observed during the 6-month follow-up period.

FLORID CEMENTO-OSSEOUS DYSPLASIA IN A YOUNG ADULT: A CASE REPORT

Florid cemento-osseous dysplasia (FCOD) is a benign fibro-osseous lesion of unknown etiology that most commonly affects the jaw of women over 40 years old. It usually appears in routine imaging exams as multiple asymptomatic mixed radiolucent-radiopaque lesions with limited cortical expansion. A 20-year-old female patient presented with multiple and extensive radiolucent lesions containing radiopaque foci, located bilaterally in the posterior mandible. Two small whitish fragments of hard consistency were removed in a biopsy procedure, and microscopic analysis revealed irregular osseous trabeculae surrounded by cellular connective tissue. The correlation between clinical-radiographic and microscopic features was consistent with FCOD. The patient was advised about the clinical behavior expected for the lesions and long-term follow-up was recommended. FCOD may affect young patients and should be included in the differential diagnosis of multiple mixed radiolucent-radiopaque lesions of gnathic bones. Florid cemento-osseous dysplasia (FCOD) is a benign fibro-osseous lesion of unknown etiology that most commonly affects the jaw of women over 40 years old. It usually appears in routine imaging exams as multiple asymptomatic mixed radiolucent-radiopaque lesions with limited cortical expansion. A 20-year-old female patient presented with multiple and extensive radiolucent lesions containing radiopaque foci, located bilaterally in the posterior mandible. Two small whitish fragments of hard consistency were removed in a biopsy procedure, and microscopic analysis revealed irregular osseous trabeculae surrounded by cellular connective tissue. The correlation between clinical-radiographic and microscopic features was consistent with FCOD. The patient was advised about the clinical behavior expected for the lesions and long-term follow-up was recommended. FCOD may affect young patients and should be included in the differential diagnosis of multiple mixed radiolucent-radiopaque lesions of gnathic bones.

DENTINOGENIC GHOST CELL TUMOR: REPORT OF THREE NEW CASES

This case series contributes with 3 new cases of dentinogenic ghost cell tumor (DGCT). Case 1 is a 44-year-old male patient with an expansive swelling in the posterior mandible of 2 years duration. It appeared as a well-defined mixed radiolucent-radiopaque (RL-RO) lesion associated with an unerupted first molar. Case 2 is a 22-year-old female patient referred for evaluation of a slow-growing asymptomatic swelling of unknown duration in the left posterior maxilla; it was a 4-cm well-defined unilocular RL-RO lesion causing resorption of adjacent molars and encroachment of the maxillary sinus. Case 3 is a 37-year-old male patient with an expansive well-defined radiolucency in the lower premolar region exhibiting root resorption. Microscopically, prominent ameloblastomatous proliferation with areas of ghost cells and dentinoid material were observed. The patients are under long-term follow-up with no signs of recurrence to date. DGCT should be microscopically distinguished from adenoid ameloblastoma with dentinoid.

CENTRAL GIANT CELL GRANULOMA ASSOCIATED WITH CENTRAL OSSIFYING FIBROMA: REPORT OF AN UNUSUAL CASE

We contribute with an uncommon case of central giant cell granuloma associated with central ossifying fibroma (CGCG-COF) in the mandible of a 38-year-old female patient. Clinically, painless swelling of 10 months' duration was detected in the anterior mandible, exhibiting prominent lingual cortical expansion. Imaging exams revealed an ill-defined multilocular mixed radiolucent-radiopaque lesion in the tooth-bearing area, measuring approximately 4 cm, causing root displacement of the lower incisors, canine, and premolars and causing exuberant expansion of bone cortices. Incisional biopsy was performed, and microscopic analysis revealed multinucleated giant cells in a hemorrhagic cellular stroma, intermingled with areas of benign fibro-osseous lesion. The diagnosis was CGCG-COF. Laboratory blood tests ruled out secondary hyperparathyroidism. The treatment consisted of marginal mandibular resection and the patient has been under strict follow-up over the last 4 months. We report an unusual case of CGCG-COF exhibiting clinical-radiographic features of aggressiveness, and long-term follow-up is required.

Craniofacial Fibrous Dysplasia of the Mandible: A Case Report and Literature Review

A 47-years-old female patient was referred to our unit due to an incidental radiographic finding of a mixed radiolucent-radiopaque lesion in the right mandible ramus. Complementary blood tests, an updated panoramic radiography and a cone beam computed tomography were performed. The incisional biopsy's histopathological report described a craniofacial monostotic fibrous dysplasia of the mandible.

EXTRANODAL ROSAI-DORFMAN DISEASE AFFECTING THE MAXILLA AND MAXILLARY SINUS: A CASE REPORT AND LITERATURE REVIEW

<h3>Introduction</h3> Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a benign, self-limiting non-Langerhans cell histiocytosis of unknown etiology. It commonly affects younger individuals in their first 2 decades of life, showing no significant gender or racial predilection. RDD traditionally presents with bilateral, painless cervical lymphadenopathy with constitutional symptoms. Examples of extranodal RDD have been described in literature, whereby the nasal cavity and paranasal sinuses are common locations, being the site of involvement in 11% of cases. <h3>Case Report</h3> This report highlights a case of extranodal RDD presenting as a progressively enlarging left maxillary intrabony mass in a previously healthy 10-year-old female patient. Radiographic examination revealed a mixed radiolucent-radiopaque lesion with poorly defined margins affecting the left maxilla, extending superiorly to involve the ipsilateral maxillary sinus. Histologic evaluation showed a diffuse infiltrate consisting predominantly of plasma cells with interspersed large cells showing a clear cytoplasm and a vesicular nuclear chromatin pattern. No active emperipolesis was seen within these large cell clear cells. CD3 and CD20 immunohistochemical stains highlighted the presence of scattered reactive T- and B-cells respectively. CD138 confirmed the presence of numerous background plasma cells, which ultimately stained positive for IgG₄. The large clear cells stained positive for S100 and CD68 but were negative for CD1a. <h3>Conclusions</h3> Because of its rarity, wide phenotypic expression, and uncertain etiology, the treatment of RDD is not standardized. Extranodal RDD affecting the craniofacial complex tends to have an indolent behavior and is often self-limiting.

EXUBERANT CEMENTO-OSSIFYING FIBROMA OF THE MAXILLA

Cemento-ossifying fibroma (COF) is a benign fibro-osseous neoplasm that commonly presents as a slow-growing, well-defined mixed radiolucent-radiopaque lesion, located in the posterior mandible of women in their third and fourth decades of life. A 59-year-old male patient was referred complaining of an asymptomatic 8 × 7 cm swelling of progressive growing in the last 5 years located in the posterior region of the maxilla. Panoramic radiograph showed a well-defined, predominantly radiopaque lesion with marked cortical bone expansion and maxillary sinus involvement. Microscopic evaluation showed proliferation of cellular fibroblastic stroma containing mineralized trabeculae of varying size and occasional concentric calcifications. There was no continuity between the tumor and surrounding normal cortical bone. The final diagnosis was COF. The patient was submitted to conservative surgery, and no recurrence was observed after 6 months of follow-up. COF of the maxilla may present as a painless and well-defined fibro-osseous tumor of large size. Cemento-ossifying fibroma (COF) is a benign fibro-osseous neoplasm that commonly presents as a slow-growing, well-defined mixed radiolucent-radiopaque lesion, located in the posterior mandible of women in their third and fourth decades of life. A 59-year-old male patient was referred complaining of an asymptomatic 8 × 7 cm swelling of progressive growing in the last 5 years located in the posterior region of the maxilla. Panoramic radiograph showed a well-defined, predominantly radiopaque lesion with marked cortical bone expansion and maxillary sinus involvement. Microscopic evaluation showed proliferation of cellular fibroblastic stroma containing mineralized trabeculae of varying size and occasional concentric calcifications. There was no continuity between the tumor and surrounding normal cortical bone. The final diagnosis was COF. The patient was submitted to conservative surgery, and no recurrence was observed after 6 months of follow-up. COF of the maxilla may present as a painless and well-defined fibro-osseous tumor of large size.

Case Presentation of Concomitant and Contiguous Adenomatoid Odontogenic Tumor and Focal Cemento-Ossifying Dysplasia.

A 24 year-old male was presented for the diagnosis of an asymptomatic bony expansion in relation to the right maxillary canine and first premolar. The unilocular radiolucent lesion with central foci of calcification had caused divergence of canine and first premolar roots without any resorption. This case report details a diagnosis of two distinct disease processes of different cellular origin namely, focal cemento-ossifying dysplasia and adenomatoid odontogenic tumor in a previously unreported concomitant and contiguous relationship. The diagnosis was determined by a combination of clinical, radiographic, histopathological and surgical evidence. This case highlights two points, first the need to examine all mixed radiolucent-radiopaque lesions with advanced imaging techniques to assess the number and extent of the lesions prior to treatment planning. Second a likely role of periodontal ligament as the tissue source for odontogenic epithelial cells and mesenchymal stem cells required for the development of odontogenic tumors and cemento-osseous dysplasias.

Histopathological Spectrum of Bone Lesions Associated with Dental Implant Failure: Osteomyelitis and Beyond

Early or late post-implant placement complications are usually localized infectious/inflammatory processes and treated accordingly. If the healing process does not take place within a reasonable timeframe, the possibility of a pathologic process beyond localized infection/inflammation should be suspected. We describe a radiological/histopathological spectrum of bony lesions ranging from inflammatory to malignant lesions surrounding failed dental implants. Five cases of mandibular dental implant failure that clinically, radiologically and histopathologically appeared to be inflammatory processes are presented. The failure of the dental implants was immediate in two cases and late in the remaining three. The radiological features were essentially similar for all five, and they included radiolucent or mixed radiolucent-radiopaque lesions with poorly defined borders. Three lesions were limited to the area of the failed implant, while the other two extended to a large part of the mandible. The histopathological findings ranged from acute osteomyelitis and chronic osteomyelitis with features of a fibro-osseous-like lesion and occasional rimming of atypical osteoblasts to osteogenic sarcoma that was admixed with a component of osteomyelitis (diagnosis of the latter was achieved only after a series of biopsies). In-depth investigative procedures are imperative in order to establish an accurate diagnosis whenever the histopathological diagnosis is inconsistent with persisting clinical signs and symptoms in bone lesions associated with failed dental implants.

Odonto calcifying cyst

The calcifying odontogenic cyst (COC) is reported to be associated with odontoma in 24% of cases. Separation of the cases of calcifying odontogenic cyst associated with odontoma (COCaO) may lead to a better understanding of the pathogenesis of this lesion. The literature revealed 52 cases of COCaO. The male to female ratio was 1:1.9, with a mean age of 16 years. Most common location was the maxilla (61.5%). The radiographic appearance of most cases (80.5%) was a well-defined, mixed radiolucent-radiopaque lesion. Histologically, the lesions consisted of a single large cyst with tooth-like structures as an integral part, giving the impression of a single lesion. In addition to the unique histologic features, differences in gender and distribution were found between the cases of COCaO and those of simple COC. COCaO may be regarded as a separate entity and classified as a benign, mixed odontogenic tumor. The term odontocalcifying odontogenic cyst is suggested.

Malignant Transformation of Calcifying Epithelial Odontogenic Tumor Is Associated With the Loss of p53 Transcriptional Activity: A Case Report With Review of the Literature

Malignant Transformation of Calcifying Epithelial Odontogenic Tumor Is Associated With the Loss of p53 Transcriptional Activity: A Case Report With Review of the Literature

Desmoplastic ameloblastoma in the anterior mandible crossing the midline: A rare variant

Desmoplastic ameloblastoma (DA) is a rare variant of ameloblastoma. One hundred and forty-five cases of desmoplastic ameloblastoma have been reported till 2007 in the literature. This article presents a rare case of desmoplastic ameloblastoma in the parasymphysial region. Review of the literature has revealed that the tumor most commonly occurs in the third to fifth decade of life, with a male predilection of 3:2. The anterior region of the maxilla is the part that is most commonly found to be affected. The radiological features reveal a mixed radiolucent-radiopaque lesion with poorly defined to well-defined borders. However, our case differed from the reviewed cases, as it was found to be with well-defined borders. The histological findings of the case were consistent with the histological appearance of the reviewed cases and showed extensive stromal desmoplasia and small tumor nests of odontogenic epithelium scattered in the stroma.

下顎前歯部に発生した腺様歯原性腫瘍中に歯原性石灰化上皮腫を含むいわゆるｃｏｍｂｉｎｅｄ ｅｐｉｔｈｅｌｉａｌ ｏｄｏｎｔｏｇｅｎｉｃ ｔｕｍｏｒの１例

Combined epithelial odontogenic tumor was first described by Damm in 1982 as a rare tumor characterized by the presence of calcifying epithelial odontogenic tumor (CEOT) areas in adenomatoid odontogenic tumor (AOT). Histologically, the tumor shows relatively small epithelial nests forming duct-like structures and markedly hyalinized fibrous tissue stroma containing amorphous and irregularly shaped calcified tissue and amyloid-like materials. There are several round-shaped masses that show Liesegang rings. This article describes a case of adenomatoid odontogenic tumor with calcifying epithelial odontogenic tumor-like areas, so-called combined epithelial odontogenic tumor, between the right lateral incisor and the left canine region in the mandible.A 27-year-old woman was referred to our clinic for evaluation of a mixed radiolucent-radiopaque lesion with a well-defined border in the mandible. A computed tomographic scan demonstrated a well-defined large lesion that extended widely, with thinning of the cortical bone of the mandible. The lesion was associated with an impacted canine in the mandible.Surgery was performed with the patient under general anesthesia.The tumor was enucleated completely via an intraoral approach. Wound healing is currently good, 9 months after surgery.

Zebra XX, Part 2

In the last issue of the Journal, the case of a 67-yr-old woman was presented. She had a dull, persistent pain of 6-months duration. A clinical intraoral examination showed the presence of a draining sinus with purulent discharge in the region of the right first mandibular molar. The patient had undergone an extraction in this area 4 months before. A panoramic X-ray showed the presence of several multiple, bilateral lesions of the mandible (Fig. 1). Periapical intraoral radiographies showed the presence of a mixed radiolucent-radiopaque lesion in the right mandible and a dense periapical radiopaque lesion located around the roots of the first left mandibular molar.

下顎骨前歯部に生じたｄｅｓｍｏｐｌａｓｔｉｃ ａｍｅｌｏｂｌａｓｔｏｍａの１例

A case of desmoplastic ameloblastoma is reported. The patient was a 77-year-old woman, who visited our hospital because of painless expansion of the anterior region of the mandible. Radiograms and CT scans revealed a mixed radiolucent-radiopaque lesion, which was poorly defined and associated with large cystic radiolucent areas. The lesion was excised, followed by the curettage of the underlining intact bone, under general anesthesia. Histologically, the lesion was composed of enamel organ-like tumor nests scattered in prominent fibrous connective tissue. Some tumor nests showed microcyst formation and transition to larger cysts. TGF-β was strongly expressed especially by tumor cells at the periphery of tumor nests, unlike conventional types of ameloblastomas. The postoperative course has been uneventful for 6 months. Clinical and radiographic characteristics of this tumor are discussed.

Radiological and clinical features of aneurysmal bone cyst of the jaws.

To evaluate the clinical and radiological features of aneurysmal bone cyst (ABC) of the jaws. A total of 64 cases (60 from the English-language literature and four new cases) were studied and critically evaluated with emphasis on the radiological features. Age at time of initial diagnosis ranged from 4-78 years, with a mean age of 21.5 years and median age of 17 years. There were no differences in gender distribution. The ratio between the mandible and maxilla was 2.4:1. Ninety-two per cent of the lesions were located in the posterior region of the jaws. Lesions were radiolucent in 87% of cases, radiopaque in 2% and mixed in 11%. Fifty-three per cent were multilocular, 43% unilocular and 3% not loculated. The border of the lesions was defined but not corticated in 39%, well defined in 33% and diffuse in 28%. ABC has a variable radiological appearance and should be considered in the differential diagnosis of any unilocular or multilocular radiolucent lesion of the jaws as well as any mixed radiolucent-radiopaque lesion.

Clinical and radiological features of odontogenic myxoma of the jaws.

To analyse critically the clinical and radiological features of odontogenic myxoma. The clinical features of 164 cases of odontogenic myxoma (two new and 162 from the literature) and the radiological features of 96 cases (two new and 94 from the literature) were analysed. Most of the tumors (75%) were diagnosed in the 2nd to 4th decades. The male to female ratio was 1:1.5. Tumors were located in the mandible in two-thirds and in the maxilla one-third of cases. A multilocular appearance was observed in 55% and unilocular in 36%; 9% were not loculated. There was a statistically significant correlation (P < 0.000) between the size of the lesion and its locularity with the larger lesions more likely to be multilocular. Only 5% of the tumors were associated with an unerupted tooth. Odontogenic myxoma has a variable clinical and radiological appearance and it should be considered in the differential diagnosis of radiolucent and mixed radiolucent-radiopaque lesions of both jaws in all age groups.

Ossifying fibroma as a mixed radiolucent-radiopaque periapical lesion

A mixed radiolucent-radiopaque lesion located at the apex of a mandibular premolar is described herein. Microscopically, this lesion was shown to be an ossifying fibroma. Differential diagnosis of these lesions is discussed, and the point is stressed that such a lesion may be easily mistaken for a much more common lesion, like a periapical granuloma or radicular cyst. The ossifying fibroma may be easily treated by curettage, but because recurrences have been observed, a careful follow-up is mandatory.

Calcifying odontogenic cyst associated with odontoma: A possible separate entity (odontocalcifying odontogenic cyst)

The calcifying odontogenic cyst (COC) has been reported to be associated with odontoma in about 24% of cases. Separation of the cases of COC associated with odontoma (COCaO) may lead to a better understanding of the pathogenesis of this lesion. A screen of the literature revealed 52 cases of COCaO. The male to female ratio was 1:1.9, with a mean age of 16 years. The most common location was the maxilla (61.5%). The radiographic appearance of most cases (80.5%) was of a well-defined, mixed radiolucent-radiopaque lesion. Histologically, the lesions usually consisted of a single large cyst (which is similar to simple COC) with tooth-like structures that appear to be an integral part of the lesion, giving the impression of a single lesion. In addition to the unique histologic features, differences in gender and in distribution were found between the cases of COCaO and those of simple COC. COCaO may be regarded as a separate entity and classified as a benign, mixed odontogenic tumor. The term odontocalcifying odontogenic cyst is suggested.