The decision was made to perform an excisional biopsy of the lesion under intravenous general anesthesia. Induction of anesthesia was performed by the anesthesia team. Throat pack was placed and a sulcular incision around the tooth was made and carried back to the tuberosity with a distobuccal releasing incision. The lesion was removed in its entirety and submitted in formalin for histopathologic review. The surgical site was irrigated and closed with 3-0 chromic gut. Throat pack was removed.

Excisional Biopsy

Histologic examination reveals multiple pieces of hard and soft tissue embedded in three separate blocks labeled A1-A3. All specimens are composed of a neoplasm of mixed odontogenic origin (Figures 2-4). The bulk of the specimen is made up of connective tissue stroma with epithelial islands. The epithelial islands are of variable shapes and sizes (Figures 2-3) and the fibrous connective tissue stroma is loose and myxoid with spindle-shaped or stellate fibroblasts suspended on delicate collagen fibers (Figures 2-3). The specimen also contains areas of hyalinized connective tissue and areas of calcified material. The latter is mostly cementum and dentin-like material (Figure 4).

Figure 2 Low power (x40) H & E histology shows mixed epithelial and odontogenic neoplasm composed of primitive connective tissue stroma with odontogenic epithelial islands, cords and rosettes of variable shapes and sizes.

Figure 3 Higher power (x200) H & E closer look histology demonstrating the epithelial islands some with palisaded cuboidal/columnar cells at the periphery and spindle-shaped to cuboidal epithelial cells in the center of the islands.

Figure 4 High power (x400) H & E histology shows calcified odontogenic material being produced by the neoplastic odontogenic epithelial cells.