Incisional and Excisional Biopsy

Three biopsies were performed: the bony nodules at the angle of the mandible and maxilla, the radiopaque mass in area of tooth #6 and the large soft tissue lesion on the scalp. The bony nodules were made up of dense lamellar bone with Haversian systems with viable osteocytes (Fig 3) consistent with osteomas. The radiopaque mass in the area of tooth #6 was made up of tooth-like structures and dental follicle (Fig 4) consistent with an odontoma while the soft tissue lesion was made up of a cystic structure filled with keratin and surrounded by a thin connective tissue wall (Fig 5) consistent with an epidermal cyst. Although the other two soft tissue lesions (on the neck and ankle) were not biopsied; they were rendered clinically to be consistent with epidermal cysts similar to that of the scalp. The patient is referred to a gastroenterologist for identification of polyps in the colon. Genetic studies will also be performed to establish a definitive diagnosis of Gardnerís syndrome.

Figure 3. Low power (x100) histology shows a large mass of lamellar bone with Haversian systems and viable osteocytes consistent with osteoma.

 

Figure 4. Low power (x40) histology shows tooth like structures and dental follicle consistent with an odontoma

Fig 5. Low power (x40) histology shows a cystic structure filled with keratin consistent with an epidermal cyst.