Imaging Sci Dent.  2019 Mar;49(1):71-77. 10.5624/isd.2019.49.1.71.

Delayed diagnosis of a primary intraosseous squamous cell carcinoma: A case report

• Abdelkarim AZ
• Elzayat AM
• Syed AZ
• Lozanoff S

• KMID: 2442112
• DOI: http://doi.org/10.5624/isd.2019.49.1.71

Abstract

Primary intraosseous squamous cell carcinoma is a rare malignant central jaw tumor derived from odontogenic epithelial remnants. Predominantly, it affects mandible, although both jaw bones may be involved. This report describes a 60-year-old man who was initially misdiagnosed with a periapical infection related to the right lower wisdom tooth. After four months, the patient presented to a private dental clinic with a massive swelling at the right side of the mandible. Panoramic radiographs and advanced imaging revealed a lesion with complete erosion of the right ramus, which extended to the orbital floor. A biopsy from the mandibular angle revealed large pleomorphic atypical squamous cells, which is the primary microscopic feature of a poorly differentiated squamous cell carcinoma.

Keyword

Carcinoma, Squamous Cell; Mandible; Delayed Diagnosis; Computed Tomography, X-Ray; Magnetic Resonance Imaging

MeSH Terms

Atypical Squamous Cells of the Cervix
Biopsy
Carcinoma, Squamous Cell*
Delayed Diagnosis*
Dental Clinics
Epithelial Cells*
Humans
Jaw
Magnetic Resonance Imaging
Mandible
Middle Aged
Molar, Third
Orbit
Tomography, X-Ray Computed

Figure

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  Fig. 1 Panoramic radiograph shows an ill-defined radiolucent lesion posterior to the right third molar with erosion of the inferior border of the mandible.

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  Fig. 2 Clinical picture over extraoral examination and panoramic radiograph. A. Supine and lateral views show a large swelling at the right side of the face. B. Panoramic radiograph shows complete erosion of the right ramus, condyle, and a portion of the mandibular body.

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  Fig. 3 Multi-slice computed tomography. A 3-dimensional reconstruction image shows complete erosion of the ramus. Axial, coronal, and sagittal slices show extension of the lesion (red arrows).

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  Fig. 4 Magnetic resonance imaging examination. Series of axial T1 (A), T2 (B), and post-contrast axial T1 (C) images showing the extension of the lesion (arrows) in the pterygoid region, maxillary sinus, and submandibular area (columns from left to right).

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  Fig. 5 Gross biopsy and histopathology examination. A. Two specimens from the angle of the mandible (3 pieces, left) and the maxillary sinus (multiple pieces, right). B. Section shows groups of large pleomorphic atypical squamous cells (arrows) with a high nucleoplasm ratio and focal intracytoplasmic keratin formation (H&E stain, ×400). C. Numerous irregularly shaped solid epithelial islands of varying sizes in the connective tissue (H&E stain, ×40). D. The basal cells are arranged in a plexiform pattern with palisading of the peripheral cells (H&E stain, ×100) (red arrows).

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