Treatment

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.