case_images: PMC10828747_01
case_images: Panoramic X-ray image at the initial administration and 18FDG-PET/CT image four years later. (A) The panoramic radiograph at the first visit shows a well-demarcated radiolucent lesion (arrowheads) in the lower anterior mandible; (B) An 18FDG-PET/CT image displays increased uptake in the bilateral lung nodules four years after mandibulectomy. 18FDG: fludeoxyglucose F18; PET: positron emission tomography
case_images: cureus-0016-00000051429-i01.jpg
case_images: PMC10828747_01_cureus-0016-00000051429-i01.jpg
case_images: FIG1
case_images: This lesion was associated with resorption of the right incisor roots and displacement of the left canine (Figure 1A). Four years after the initial surgery, 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18FDG-PET/CT) image revealed increased uptake in bilateral lung nodules (Figure 1B), raising suspicion of pulmonary metastasis.
case_images: Pathological features. The cutting surface of the resected specimen exhibits a relatively well-marginated, light greyish lesion that entirely occupies the anterior alveolar bone, encircling the left first incisor (A). Histologically, muscular invasion (arrows) is evident at the labial side of the mandible. The tumor is divided into two parts, indicated by a red line, with a sclerotic area labeled "Sc" and a higher-cellular area labeled "Cc," featuring ischemic necrosis (asterisks) (B).
case_images: cureus-0016-00000051429-i02.jpg
case_images: PMC10828747_01_cureus-0016-00000051429-i02.jpg
case_images: FIG2
case_images: Ischemic necrosis was observed in some areas (Figure 2).
case_images: Histopathological findings. (A) The tumor comprises a minor area, typifying sclerosing odontogenic carcinoma, with cords of epithelium proliferating within the collagenous stroma. Notably, perineural invasion is observed (inset); (B) The major portion consists of solid nests with hyalinized stroma; (C) The thin cords of nests comprise cuboidal, bland epithelium interspersed with a few atypical cells; (D) Solid nests comprise large polygonal and clear cells with centrally located nuclei exhibiting irregular contours; (E) The clear cytoplasm contains periodic acid-Schiff-positive granules (arrows), which are digested by diastase (inset); (F) Elastin Van Gieson stain highlights tumor nests invading a vascular lumen (arrows)
case_images: cureus-0016-00000051429-i03.jpg
case_images: PMC10828747_01_cureus-0016-00000051429-i03.jpg
case_images: FIG3
case_images: Elastin Van Gieson Stain revealed significant vascular invasion (Figure 3).
case_images: Immunohistochemical and fluorescence in situ hybridization findings. All tumor cells demonstrate diffuse positivity for cytokeratin 8 (A), cytokeratin 19 (B), and p63 (C). Ki-67-positive cells are notably prevalent in the hotspots, with an index of 23% (D). FISH analysis using break-apart probes for EWSR1 (E) and MAML2 (F) shows no split signals. Bars in (E) and (F) represent 10 mum.. FISH: fluorescence in situ hybridization
case_images: cureus-0016-00000051429-i04.jpg
case_images: PMC10828747_01_cureus-0016-00000051429-i04.jpg
case_images: FIG4
case_images: Consequently, the patient was diagnosed with SOC showing CCOC features due to the absence of EWSR1 rearrangement (Figure 4).