Forum for Clinical and Surgical Oral Pathology

Case BBOPF 22-2

Dr. Ivan Stojanov (Case Western Reserve University, School of Dental Medicine, Cleveland, OH. USA) is seeking you input for an unusual case. The case will be posted until February 25, 2022. A summary of the response will ensue shortly after.

History

A 90M presented to OMFS with a 4.0 cm ant. maxillary RL of unknown duration, exhibiting buccal and palatal expansion but no cortical perforation or erosion (per the surgeon). At time of surgery, a variably solid/cystic mass was encountered with no evidence of encapsulation, but the surgeon claims the lesion was easily removed in its entirety. Received grossly was a ruptured cyst and curettings of soft tissue. Histologic images, attached, show a poorly characterizable odontogenic cystic/neoplastic process. By immunohistochemistry, tumor cells are positive for AE1/3, CK19, p40; and negative for BRAF, beta-catenin (cytoplasmic only), INSM-1. Ki-67 is < 1%.

Questions

Has anyone seen a case similar to this and have a diagnosis?

Ivan Stojanov, D.M.D.
Assistant Professor
Case Western Reserve University School of Dental Medicine
Cleveland, OH

Images

Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (University at Buffalo School of Dental Medicine).