Aggressive juvenile fibroma of the mandible

Selected US, X-ray and CT images are shown here;there is a small lytic expansile lesion associated with soft tissue component is seen seen at right mandibular angle which is a FNA proven eosinophilic granuloma.

The whole body bone scan shows focal irregular mild increased uptake of  radiotracer in the region of  right mandibular angle.                         

As you do see in the X Ray images, the right angle of mandible has an exophytic lytic mass which is not developing to the tooth roots.

Color dopler ultrasound scan shows that the above-mentioned mass has a soft tissue component with peripheral hypervascularity.

He underwent a whole body bone scan with 99 mTC-MDP  prior to surgery for the assessing of probable distant metastasis or ruling out of any secondary lesion.At first, using FNA proven examination, we thought it was an eosinophilic granuloma of the mandible, but further examinations by exisional biopsy revealed it to be an agressive juvenile fibroma.

The 9-year old boy was refered for further evaluationevaluations because of the otolaryngologist palpate the hard nodule in the right mandiular angle before tonsilectomy .