Imaging Sci Dent.  2012 Dec;42(4):265-270. 10.5624/isd.2012.42.4.265.

Primary intraosseous squamous cell carcinoma mimicking periapical disease: a case report

• Choi YJ
• Oh SH
• Kang JH
• Choi HY
• Kim GT
• Yu JJ
• Choi YS
• Hwang EH

• KMID: 1806795
• DOI: http://doi.org/10.5624/isd.2012.42.4.265

Abstract

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare carcinoma, which arises within the jaws without connection to the oral mucosa and presumably develops from a remnant of odontogenic epithelium. We present a case of solid type PIOSCC in a 52-year-old male patient complaining of dull pain on his left lower molar. In this case, early stage PIOSCC mimicking a periapical lesion might lead to a one-year delay in treatment due to the misdiagnosis of osteomyelitis after extraction of the third molar. The clinical, radiological, and histologic features are described. In this case, there was initial radiographic evidence for PIOSCC mimicking a periapical lesion. Incautious radiographic interpretation and treatment procedures had delayed the correct diagnosis and resulted in extensive bony destruction during the patient's disease progression.

Keyword

Carcinoma, Squamous Cell; Head and Neck Neoplasms; Periapical Disease; Mandible

MeSH Terms

Carcinoma, Squamous Cell
Diagnostic Errors
Disease Progression
Epithelium
Head and Neck Neoplasms
Humans
Jaw
Male
Mandible
Middle Aged
Molar
Molar, Third
Mouth Mucosa
Osteomyelitis
Periapical Diseases

Figure

• 

  Fig. 1 Cropped panoramic (A) and periapical (B) radiographs show an ill-defined periapical rarefaction coinciding with external root resorption related with the follicular space of the impacted third molar.

• 

  Fig. 2 CBCT images show external root resorption on the distal root and extensive bony lysis over the apex of the second molar from the follicular space of the impacted third molar.

• 

  Fig. 3 CBCT images reveal an extensive and ill-defined bony destruction with the perforation of the buccal and lingual cortical plates.

• 

  Fig. 4 Photomicrographs of the lesion show moderately differentiated squamous cells and solid tumor tissue with cellular atypia and pleomorphism. (H&E stain, A. ×40, B. ×400)

• 

  Fig. 5 Coronal magnetic resonance images show a mass in the left posterior area. A. T1-weighted image shows heterogeneous hypo- to isointensity, B. Contrast-enhanced T1-weighted image, shows a strong heterogeneous enhancement.

• 

  Fig. 6 Axial 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT images show FDG accumulation in the lesion in the left mandible (standardized uptake value; SUVmax=10.9).

Reference

1. Barnes L, Eveson JW, Reichart P, Sidransky D. World Health Organization classification of tumours: Pathology and genetics of head and neck tumours. 2005. Lyon: IARC Press;290–291.

2. Eversole LR. Malignant epithelial odontogenic tumors. Semin Diagn Pathol. 1999. 16:317–324.

3. Pindborg JJ, Kramer IR, Torloni H. International histological classification of tumours, No. 5. Histological typing of odontogenic tumours, jaw cysts, and allied lesions. 1971. Geneva: World Health Organization;35–36.

4. Elzay RP. Primary intraosseous carcinoma of the jaws. Review and update of odontogenic carcinoma. Oral Surg Oral Med Oral Pathol. 1982. 54:299–303.

5. Slootweg PJ, Müller H. Malignant ameloblastoma or ameloblastic carcinoma. Oral Surg Oral Med Oral Pathol. 1984. 57:168–176.

6. Waldron CA, Mustoe TA. Primary inraosseous carcinoma of the mandible with probable origin in an odotogenic cyst. Oral Surg Oral Med Oral Pathol. 1989. 67:716–724.

7. Suei Y, Tanimoto K, Taguchi A, Wada T. Primary intraosseous carcinoma: review of the literature and diagnostic criteria. J Oral Maxillofac Surg. 1994. 52:580–583.

8. Lugakingira M, Pytynia K, Kolokythas A, Miloro M. Primary intraosseous carcinoma of the mandible: case report and review of the literature. J Oral Maxillofac Surg. 2010. 68:2623–2629.

9. Kaffe I, Ardekian L, Peled M, Machtey E, Laufer D. Radiological features of primary intra-osseous carcinoma of the jaws. Analysis of the literature and report of a new case. Dentomaxillofac Radiol. 1998. 27:209–214.

10. Thomas G, Pandey M, Mathew A, Abraham EK, Francis A, Somanathan T, et al. Primary intraosseous carcinoma of the jaw: pooled analysis of world literature and report of two new cases. Int J Oral Maxillofac Surg. 2001. 30:349–355.

11. Hwang EH, Choi YS, Lee SR. Primary intraosseous carcinoma of the mandible. Korean J Oral Maxillofac Radiol. 2005. 35:235–239.

12. Thomas G, Sreelatha KT, Balan A, Ambika K. Primary intaosseous carcinoma of the mandible - a case report and review of the literature. Eur J Surg Oncol. 2000. 26:82–86.

13. Dimitrakopoulos I, Psomaderis K, Asimaki A, Papaemanouel S, Karakasis D. Primary de novo intraosseous carcinoma: report of two cases. J Oral Maxillofac Surg. 2005. 63:1227–1230.

14. To EH, Brown JS, Avery BS, Ward-Booth RP. Primary intraosseous carcinoma of the jaws. Three new cases and a review of the literature. Br J Oral Maxillofac Surg. 1991. 29:19–25.

15. Woolgar JA, Triantafyllou A, Ferlito A, Devaney KO, Lewis JS Jr, Rinaldo A, et al. Intraosseous carcinoma of the jaws: a clinicopathologic review. Part III: primary intraosseous squamous cell carcinoma. Head Neck. (in press).