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Oral Pathology:  Bone Case #3

 

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Patient: 58 year old man

Chief Complaint:
The patient reports swelling in the left mandible of 3 months duration. The swelling is not painful.

Medical History:
No abnormalities are identified.

Dental History:
No abnormalities are identified.

Clinical Findings:
Nontender bony expansion is palpated in the left body of the mandible. Radiographic examination reveals a radiolucent lesion with well-defined, corticated borders. No other abnormalities are identified.

There are no clinical images available for this case.

Radiograph
radiograph

 

There are no lab reports available for this case.

There are no charts available for this case.

Summary:
This lesion is nonpainful, enlarged, and radiolucent with well-defined, corticated borders radiographically.

Lesions to Include/Exclude:
Exclude diffuse lesions because they present with ill-defined borders radiographically.

Due to location, we cannot exclude some of the odontogenic tumors and cysts from our differential diagnosis.

Exclude radicular cyst, lateral periodontal cyst and dentigerous cyst because they are associated with teeth.

Exclude incisive canal cyst because of location.

Exclude odontogenic myxoma because it is diffuse.

Exclude periapical cemental dysplasia because these must be associated with teeth.

Exclude odontomas and cementoblastoma because of radiographic appearance.

Exclude monostotic fibrous dysplasia because it is diffuse.

Exclude Stafne defect because of location.

This lesion doesn't help us out too much. We must include several lesions in the differential diagnosis: residual cyst, primordial cyst, keratocyst, ameloblastoma, ameloblastic fibroma, odontogenic fibroma, adenomatoid odontogenic tumor, calcifying epithelial odontogenic tumor, ameloblastic fibro-odontoma, calcifying odontogenic cyst, non-ossifying fibroma, central giant cell granuloma, ossifying/cementifying fibroma, early chondroma, early osteoma, hemangioma and idiopathic bone cavity.

We can probably exclude hemangioma because there would have been a bleeding episode when the teeth in the area were extracted.

Histologic examination defines this lesion as a neurofibroma of bone which has characteristics similar to those of a non-ossifying fibroma.

Management:
Treatment of this lesion includes conservative enucleation of the lesion and submission of the tissue for microscopic examination. No further treatment, other than routine follow-up, would be needed after the microscopic diagnosis.

Prognosis:
Recurrence rate is low and enucleation results are curative.