COTM | British Society for Oral & Maxillofacial Pathology

case of the

month

2021

COTM OCTOBER/november 2021

Case Credit- Dan Brierley, Olive Allsobrook, Paul Hankinson (Sheffield, UK), Adam Levene, Valmiki Sharma (Luton)

CLINICAL DETAILS

A 59 year old female presented to her dentist with an expansile lesion in the left body of the mandible with a one year history. She was referred to the local specialist oral and maxillofacial surgery unit. The patient complained of a foul taste in her mouth, progressive mobility of her lower left quadrant teeth and paraesthesia. A tender hard lump was palpable in the region as well. Imaging showed a multilocular mixed radio-opaque/radiolucent lesion in the left parasymphysis/body of mandible associated with an ectopic LL5. A CT scan showed thinning of the buccal and lingual cortices but no evidence of bone destruction.

The patient underwent a biopsy of the lesion for histopathological analysis.

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COTM 2020

COTM 2019

COTM 2018

COTM SEPTEMBER 2021

Case Credit- Ali Khurram & Olive Allsobrook (Sheffield, UK)

CLINICAL DETAILS

A 63 year old male patient presented with a 5 month history of oral ulcers and soreness. The symptoms involved the tongue / gums / inner lip and throat with signinficant discomfot during eating. The patient had a medical history of Crohn's, HTN, GORD and asthma and was taking a number of relevant medications. He was non-smoker and had no history of alcohol intake. Examination showed multiple ulcers involving the floor of mouth, labial/buccal sulci and buccal mucosa.

The patient underwent a biopsy of these lesions for histopathological analysis.

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COTM JULY/AUGUST 2021

Case Credit- Ali Khurram & Olive Allsobrook (Sheffield, UK)

CLINICAL DETAILS

A patient presented with an alveolar ridge swelling in the lower left central incisor region. Examination showed a well defined soft tissue swelling involving the gingival tissue. Radiology (plain radiographs and CT scans) showed a 12 mm lesion in the mandibular symphysis centered over the LL1 but extending laterally to LR1 and LL2. There was no evidence of an intra-osseus lesion. A provisional diagnosis of a soft tissue (non dental) lesion likely related to trauma was made.

The patient underwent removal of the lesion and the tissue was sent for histopathological analysis.

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COTM JUNE 2021

Case Credit- Paul Hankinson & Dan Brierley (Sheffield, UK)

CLINICAL DETAILS

A 71 year old male patient presented with a swelling involving the right floor of mouth. The swelling had been present for an unknown duration with an increase in size. MRI showed a lesion involving the right sublingual space and anterolateral tongue measuring 4.3 cmx1.9cm. The lesion had displacedthe genioglossus and hyoglossus muslces. There was no evidence of extrinsic muscle infiltration. Bone and masticator space invasion were also not seen and there was no evidence of lymphadenopathy. an ultrasound scan also confirmed normal sublingual salivary gland.

The patient underwent removal of the lesion and the tissue was sent for histopathological analysis.

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COTM MAY 2021

Case Credit- Ali Khurram (Sheffield, UK)

CLINICAL DETAILS

A 31 year old male patient presented with a history of recurrent discharge from anterior neck. The patient had undergone removal of a cyst from his neck 3 years ago. MRI and ultrasound imaging showed a fluid containing cystic lesion in the anterior neck subcutaneous tissue measuring 2.2x1.2 cm. There was reactive lymphadenopathy. No other pathology was evident. A provisional diagnosis of Thyroglossal Duct Cyst was made.

The patient underwent removal of the cystic lesion along with part of the underlying hyoid bone.

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COTM APRIL 2021

Case Credit- Daniel Brierley and Olive Allsobrook (Sheffield)

CLINICAL DETAILS

A 21 year old female patient presented with a history of discomfort involving the URQ. The UR4 and UR6 had undergone root canal treatment however, there was an ectopic UR5 with a surrounding dental follicle causing resorption of the UR4 and UR6 roots. The patient was referred to tertiary care for orthograde root canal treatment in UR4 and UR6 prior to surgical removal of the UR5 and associated cystic tissue.

The patient underwent removal of the UR5 and associated tissue.

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COTM march 2021

Case Credit- Daniel Brierley and Olive Allsobrook (Sheffield)

CLINICAL DETAILS

A 69 year old male presented with a lump involving the lip. The lesion had a few months history with occasional discomfort but no significant symtpms. mucocoele and minor salivary gland. Examination showed a nodular lesion which was firm on palpation. The clinical differential diagnosis included fibro-epithelial polyp or an atypical mucocoele.

The patient underwent an incisional biopsy of the lesion.

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COTM JANUARY 2021

Case Credit- Dr Amber Kiyani & Professor Adnan Aslam (Islamabad, Pakistan)

CLINICAL DETAILS

A 20 year old male patient presented with a 2 month history of a nose bleed. Clinical examination showed a large, expansile lesion with a palpable mass in the left hard palate. There was evidence of ulceration with extension into the left nostril as well as the left buccal sulcus. A CT scan obliteration of the left maxillary sinus by a 5.3x6.3x5.4cm lesion with evidence of invasion into the hard palate and nose. Erosion of the pterygoid plates was also seen in addition to nsal septum deviation, expansion of the ethmoid sinus, involvement of nasolacrimal duct as well as overlying skin.

The initial histological impression on biopsy was that of a sarcoma. The patient underwent a left sided maxillectomy for removal of the lesion.

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COTM FEBRUARY 2021

Case Credit- Miss Manjinder Jandu and Elizabeth Offen (Rotherham)

CLINICAL DETAILS

A 64 year old male patient presented with an ulcer involving the tongue. The patient gave a 7 weeks history of the ulcer with progressive increase in size over that period. A course of anti-fungal treatment had failed to resolve the ulcer. Upon examination, a well defined ulcer with an approximately 12 mm diameter was seen involving the left dosrum of tongue. The ulcer appeared flat with no evidence of raised or rolled borders. There was no history of trauma