A 86-year-old patient consulted the maxillofacial surgery team at the San José Hospital due to an asymptomatic increase in volume, with an uneventful evolution in the anterior mandibular zone.
The patient had a history of hypertension and type 2 diabetes controlled by conventional medical treatment.
She had no history of smoking or alcohol consumption.
On physical examination, a large increase in volume in the anterior mandibular zone of firm consistency and tenderness could be observed.
The skin and mucosa that rectified the lesion had normal characteristics, without associated lymphadenopathy.
There was no associated motor or sensory neurological compromise.
A computed tomography (CT) was requested, where in its axial images a hypodense lesion of multilocular aspect was observed, extending from the region corresponding to the right canine zone first molar to the contralateral region corresponding to the perforation.
Incisional biopsy was programmed and a drainage tube was installed in order to diagnose the lesion.
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Histopathological study of the sample revealed a cystic cavity arising from a parakeratinized polystratified parakeratinized cystic cavity with a basal stratum of cylinical cells with hyperchronous nucleus arranged in palisade epithelium.
Based on these findings, the lesion was diagnosed as a keratocystic odontogenic tumor.
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With this diagnosis it was decided to continue the depressive therapy and control the patient.
After 2 weeks, the patient presented pain and functional impotence that increased until preventing feeding after 2 months of drainage.
With this evolution a new CT was requested in which it could be confirmed that the compressive therapy did not meet its objective, since there was an increase in the lingual compromise of the tissues resulting from the lesion Table, in relation to the destruction of the previous conditions.
After 3 weeks of performing the closure procedure and taking into account new clinical and radiophysical findings, exeresis of the lesion plus curettage and application of surgical solution in Carno was performed.
A mandibular reconstruction plate was used to treat the underlying bone defect.
The surgical specimen was sent to histopathological study which reported the presence of a cystic membrane with anaplastic epithelial tissue, prominent loss of cytoplasm, epithelial stratification, cellular and nuclear pleomorphism, loss of nucleic ratio.
The proliferation presented a distinctive pattern towards the underlying connective tissue.
In other sectors of the sample, epithelial proliferation nests and islots were observed in cystic wall thickness, which showed the same characteristics as those observed in honeycombing.
Based on these histopathological findings, the diagnosis of moderately differentiated intraosseous squamous cell carcinoma was emitted.
Imaging tests were requested, including chest X-ray, total scan and bone scintigraphy, which ruled out metastases and/or possible primary tumors.
The patient was referred for cancer treatment, dying from pneumonia.
