A 32-year-old Japanese woman, with no relevant medical-surgical history, non-smoker or drinker, came to consultation for presenting a painless maxillary tumor of several months evolution.
On examination, a tumor measuring about 3 cm in diameter was observed, which was prominent in the left vestibular premolar area of the upper jaw, maintaining the integrity of the mucosa.
No associated malformations and cervical exploration was negative.
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In the panoramic radiograph, a mixed radio-opaque image of the sinus is observed, with a "panal" appearance of bees, which expands between the light canine and the first bicuspid maxillary displacement.
Computed tomography (CT) more accurately delineates the edges of this tumor, which extends through the palatal region without reaching the midline; in its central area presents a clear radiolucent image surrounded by radiolucent images.
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The differential diagnoses expected for histological confirmation were: benign fibroosseous lesion, osteogenic sarcoma, calcifying epithelial tumor, etc.
The first biopsy performed was reported as ameloblastoma, but the lack of clinical-radiological concordance with the common ameloblastoma supported the indication for a second biopsy.
It was possible to observe more clearly scarce nests and cords of basaloid cells, without atypia, arranged in a densely collagenized fibrous stroma, which was considered characteristic of the ameloblastoma variant.
Under general anesthesia, a palatal and vestibular mucosal flap was dissected in the peritumoral area, as well as the separation of the nasal mucosa and maxillary sinus, which were not adhered to the tumor at any time.
After exposing the area to be exposed and following the macroscopic limits of the tumor, a maxillectomy is performed, covering from the distal sinus of the affected lateral palatal floor to the mesial of the second molar, including the left maxillary wall.
Once the tumor block is removed, the safety limits of resection on clinically healthy bone are extended.
In the same surgical procedure, the resulting defect is reconstructed by interposition of a free cortico-cancellous self-injection block of the hip, fixing it with mini-plates of the jawbone.
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The macroscopic study of the resection specimen showed a tumor measuring 3 x 3 and 5 x 2.5 cm, relatively well defined but not extensive to the borderline bone.
Histologically, the tumor consisted of irregular nests of basaloid cells with low cytoplasm and monomorphous nuclei without atypia.
Cell nests were arranged in a salpicious manner over an abundant collagenized stroma.
A report of ameloblastoma variant of desmos respected bone borders was issued.
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The immediate postoperative course was uneventful and a provisional removable dental prosthesis was placed after a few weeks.
In the last clinical follow-up to be performed at 4 years there are no signs of recurrence; a year and a half after the intervention was performed, for greater safety, a histological examination of the remaining bone in the presence of the residual tumor resection line was performed.
Periodic reviews are maintained.
