Clinical Findings

Clinical examination revealed a firm, pink, fleshy mass in the left posterior mandible with intact surface and displaced teeth numbers 19, 20, and 21 (Figures 1).   Multiple radiographic images—panoramic (Figure 2), and computed tomography (CT) scan (Figure 3) were taken and all revealed a destructive soft tissue lesion with significant buccal and lingual expansion.  An incisional biopsy was performed.  Once the diagnosis was obtained, the patient was planned for an excisional biopsy of the entire lesion.

Figure 1 Occlusal view. Photograph taken at first clinical presentation to Children’s Hospital. Note the pink/red, sessile swelling expanding the mandible both buccal and lingual displacing teeth #s 19 and 21. Lingual expansion is more prominent. Tooth # 20 is completely covered by the neoplasm.

 

Figure 2 Panoramic radiograph demonstrating bone resorption, left mandible in the area of teeth # 19-21. This radiograph reveals a well-demarcated destructive soft tissue lesion. The bone in the area is almost all resorbed giving the impression of teeth floating in space.

 

Figure 3 Computed tomography (CT) scan image reveals a destructive soft tissue lesion with significant buccal and lingual expansion.