case_images: PMC4860916_01
case_images: Gingival lesion at first evaluation. Note, the mandibular gingival recession bounded between right central incisor and first left premolar
case_images: JOMFP-20-137-g002.jpg
case_images: PMC4860916_01_JOMFP-20-137-g002.jpg
case_images: F1
case_images: The growth site was associted with gingival recession (Miller's Class III) [Figure 1].
case_images: Radiographic findings. Optical projection tomography: Radiolucency was appreciable between the left mandibular canine and first premolar teeth (arrow)
case_images: JOMFP-20-137-g003.jpg
case_images: PMC4860916_01_JOMFP-20-137-g003.jpg
case_images: F2
case_images: No signs of radiographic root resorption were detected [Figures 2 and 3].
case_images: (a) Computed tomography scan (occlusal view) showing buccal cortical bone loss. (b) Computed tomography showing buccal cortical bone loss
case_images: JOMFP-20-137-g004.jpg
case_images: PMC4860916_01_JOMFP-20-137-g004.jpg
case_images: F3
case_images: No signs of radiographic root resorption were detected [Figures 2 and 3].
case_images: (a) Proliferation of ovoid and fusiform epithelioid cells with nuclear and cellular pleomorphism arranged in nests and cords forming small vascular channels (H&E stain, x100). (b) The Ki-67 index was 20% (IHC stain, x100). The neoplastic cells were positive for (c): CD31 in both stromal and endothelial cells (IHC stain, x100) and (d): CD34 (IHC stain, x100)
case_images: JOMFP-20-137-g005.jpg
case_images: PMC4860916_01_JOMFP-20-137-g005.jpg
case_images: F4
case_images: The lesion exhibited small vascular channels with a moderate cellular inflammatory infiltrate, composed mainly of lymphocytes, plasma cells and eosinophils surrounding the vessels [Figure 4]. Thus, a diagnosis of MEH was made [Figure 4].
case_images: (a-d) Surgical excision and reconstruction of the mandible with an iliac crest bone graft
case_images: JOMFP-20-137-g006.jpg
case_images: PMC4860916_01_JOMFP-20-137-g006.jpg
case_images: F5
case_images: Mandibular reconstruction and stabilization were obtained by an iliac bone crest graft fixed with titanium reconstruction plates and screws [Figure 5].
case_images: Radiographic findings 4 years after bone reconstruction
case_images: JOMFP-20-137-g007.jpg
case_images: PMC4860916_01_JOMFP-20-137-g007.jpg
case_images: F6
case_images: The entire follow-up period was 46 months [Figure 6].
case_images: Involvement of bone and mucosa by the malignant cells (a) H&E stain, x40, (b) H&E stain, x400. Cells positive for (c) Ki-67 (IHC stain, x200) and (d) CD 31 (IHC stain, x100). (e) lymph node metastases (H&E stain, x40)
case_images: JOMFP-20-137-g008.jpg
case_images: PMC4860916_01_JOMFP-20-137-g008.jpg
case_images: F7
case_images: After ultrasonography and computed tomography, a bilateral selective neck dissection was performed and those nodes at levels 1-3 were excised; in addition, the submandibular glands were removed bilaterally with all associated nodes [Figure 7].