case_images: PMC10798835_01
case_images: Intraoral photograph, showing a little nodule with an apparently sessile base, located in the palatal mucosa behind the upper right central incisor, noting resin restoration.
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case_images: fig1
case_images: Clinical examination revealed a nodule with an apparently sessile base, but narrow in the anteroposterior aspect, with a smooth surface and a slight white color with diffuse posterior erythema (Figure 1). The peripheral cells of the nests had ameloblastoma-like features; however, inversed polarization was not typical; and dispersed dentinoid material was also observed (Figure 3(b), Supplementary figure 1-A). Also, numerous multinucleated foreign body giant cells were found both in the center of the solid nest and outside it and were accompanied by a moderate chronic inflammatory infiltrate (Supplementary figure 1-B). Immunohistochemistry reactions for CKAE1/AE3 and CK19 evidence a central negative zone in the largest nest, confirming the presence of a lumen occupied by the foreign body reaction induced by the ghost cells (Figure 3(d), Supplementary figure 1-C, D). Additionally, the presence of islands and cords of odontogenic epithelium around the cystic epithelium was noted (Figure 3(e), Supplementary figure 1-C). An Ki67 immunoreaction showed a <2% proliferative index in the basal cells of the nests (Supplementary figure 1-E).
case_images: Radiological images. (a) Panoramic X-ray, showing the bone integrity at the level of the upper right central incisor. (b) Periapical radiograph, showing a horizontal coronary fracture of the upper right central incisor can be seen, affecting only enamel and dentin. (c) Periapical radiograph. It can be observed that the length of the tooth is apparently shorter compared with its contralateral counterpart; in addition, the apical region is irregular; however, its formation is complete.
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case_images: fig2
case_images: Panoramic and periapical radiographs were performed, in which no bone involvement was observed (Figure 2).
case_images: Microphotographs illustrating histopathological findings of the lesion. (a) Panoramic visualization shows a polypoid conformation, one nest, and one cystic-like structure that can be seen in the center of specimen (hematoxylin and eosin (HE) stain; x20 magnification). (b) Ameloblastoma-like epithelium in the periphery of the nest, dentinoid material, and groups of ghost cells can be seen; additionally, numerous foreign-body type multinucleated giant cells intermixed toward inside and outside in the stroma are seen too (HE stain; x100 magnification). (c) Conspicuous groups of ghost cells (HE stain; x400 magnification). (d) CKAE1/AE3 immunoreaction. The luminal space occupied by inflammatory body reaction is negative (x20 magnification). (e) CK19 immunoreaction, cords, and island of odontogenic epithelium surrounding the cystic structures can be identified; it can also be seen in image (d) (x100 magnification).
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case_images: fig3
case_images: Microscopically, a pedunculated mass with two epithelial nests in the center of the specimen was observed, the bigger of them apparently solid, while the minor was cystic, both surrounded by a fibrous stroma in concentric arrangement (Figure 3(a)). The peripheral cells of the nests had ameloblastoma-like features; however, inversed polarization was not typical; and dispersed dentinoid material was also observed (Figure 3(b), Supplementary figure 1-A). Immersed into the epithelial cells resembling the stellate reticulum of the enamel organ, groups of ghost cells were identified (Figure 3(c)). Immunohistochemistry reactions for CKAE1/AE3 and CK19 evidence a central negative zone in the largest nest, confirming the presence of a lumen occupied by the foreign body reaction induced by the ghost cells (Figure 3(d), Supplementary figure 1-C, D). Additionally, the presence of islands and cords of odontogenic epithelium around the cystic epithelium was noted (Figure 3(e), Supplementary figure 1-C).
case_images: Clinical photographs of follow-up. (a) After three months, a complete recovery is observed. (b) At 4 years of follow-up, no recurrence was observed.
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case_images: fig4
case_images: Subsequently, at 3-month and 4-year follow-ups, no evidence of recurrence was observed (Figure 4).