Treatment

Under local anesthesia, an incisional biopsy was performed.  After histopathologic review verified the diagnosis, a complete surgical removal was performed under local anesthesia per the patient’s request.  Tooth #30 was extracted at the time of surgical resection and resection of the tumor was performed with a combination of blunt and sharp dissection and the use of a laser.  Due to the extension of the tumor into the lingual mandible, care was taken to preserve the lingual nerve. The underlying mandibular bone was curetted with rotary instrumentation and copious irrigation.  Local flaps were then advanced for soft tissue closure.  The patient was referred to his primary care physician for evaluation for hyperparathyroidism.  Lab results were all within normal limits and included a Parathyroid Hormone Intact Molecule of 35 pg/ml (normal: 12 – 88).

Incisional Biopsy

Histologic examination of the H & E sections from both the incisional specimen and the surgical specimens were similar in morphology.  They were made up of mostly ulcerated surface epithelium with underlying cellular and vascular granulation tissue (Figure 3) containing numerous giant cells (Figures 4 & 5).  The giant cells were of variable shapes and sizes haphazardly arranged.  Clusters of hemosiderin pigment were present, especially in the superficial lamina propria (Figures 4 & 5).  Also present were clusters of extravasated erythrocytes scattered throughout the granulation tissue stroma (Figures 4 & 5). 

Figure 3 Low power (x40) the H & E histology reveals a mass of vascular and cellular granulation with ulcerated surface epithelium.

Figure 4 Low power (x100) the H & E histology of a slightly higher power shows the granulation tissue to contain numerous giant cells of variable shapes and sizes. Also present are clusters of extravasated erythrocytes and small clusters of hemosiderin pigment.

Figure 5 High power (x400) the H & E histology shows vascular granulation tissue with numerous giant cells, hemosiderin pigment and clusters of extravasated erythrocytes.