Treatment

Under local anesthesia, teeth #s 29-31 were extracted and the area thoroughly curetted.  Post operative healing was yielding good results.  However on the seventh week, the patient returned with small red-purplish areas (Figure 3) in the healing sockets.  The lesions were re-biopsied to reveal residual pathology.  The area was curetted and the patient is healing well since. 

Incisional and excisional biopsy

Histological examination revealed sheets and clusters of large cells with abundant cytoplasm and folded, grooved or bean shaped nuclei intermixed with many eosinophils and a few multinucleated giant cells (Figures 4 & 5).  The immunohistochemistry stain showed strong membrane expression with CD1a antibody (Figure 6) and uniform nuclear and cytoplasmic positivity with S-100 antibody (Figure 7).  A few mitotic figures were identified.   

 

Figure 3 Photograph taken seven weeks post extraction and curettage. Note the small red areas overlying the healing socket.

 

Figure 4 Low power (x100) H & E histology shows clusters of large round cells with abundant cytoplasm and bean-shaped and folded nuclei intermixed with many eosinophils.

 

Figure 5 High power (x200) H & E histology shows clusters of large cells with abundant cytoplasm and folded nuclei intermixed with many eosinophils.

Figure 6 High power (x200) immunohistochemistry stain with CD1a antibody. Note the uniform and strong cell membrane positive stain.

Figure 7 Low power (x100) immunohistochemistry stain with S-100 protein antibody. Note the uniform and strong nuclear and cytoplasmic positive stain.