Case report
A 40-year-old female patient was referred to the oral surgery department
for the management of a radiolucent lesion associated with the right
mandibular impacted wisdom tooth of incidental discovery. Her familial
and past medical history was non-contributory. She was asymptomatic.
The extraoral examination was normal. The intraoral examination showed a
well-circumscribed mandibular sessile nodule distal to tooth 47,
extending on both vestibular and lingual gingiva and measuring
approximately 1 cm in diameter. It was covered by normal mucosa and firm
on palpation. Tooth 48 was clinically absent (Figure 1). Radiographic
examination using panoramic radiograph showed a unilocular expansile
radiolucent homogenous image on the right mandibular angle, associated
with an impacted wisdom tooth 48. A cone beam computed tomography was
required to precisely determine lesion expansion and limits. The lesion
measured 2 cm × 1.5 cm × 1 cm and its limits were well-defined. The
cortical bone and the mandibular canal were respected. (Figure 2)
Clinical and radiological findings let suspected many diagnoses, such as
odontogenic cysts, odontogenic keratocyst, dentigerous cyst,
ameloblastoma and osteolytic lesion related to the brown tumor.
Parathormone, vitamin D, phosphor and calcium serum levels were
requested. There were within the normal limits except for the decreased
vitamin D level.
Total enucleation of the lesion was performed under local anesthesia,
with the impacted wisdom tooth extraction.
Histopathological examination revealed a nodule formed by trabeculae and
clusters of polyhedral epithelial cells, focally united by intercellular
bridges. They had an eosinophilic cytoplasm and regular finely nucleated
nuclei. These epithelial cells were separated by interspersed hyaline
fibrous tissue, little cellular by places, globular, taking the aspect
of amyloid-like material (Figure 3). This substance showed brick red
color on Congo red staining (Figure 4). The diagnosis of a
non-calcifying epithelial odontogenic tumor was consequently confirmed.
The post-operative period was uneventful. The patient continues to be on
regular follow-ups. No sign of recurrence was detected after six months
follow-up.