Floating tooth: maxillary metastasis

Case contributed by Dr Henry Knipe

Presentation

Facial pain.

Patient Data

Age: 65 years
Gender: Male
Modality: X-ray

Resorption of the superior alveolar ridge centrally with a floating tooth. Solitary mandibular tooth.

Modality: CT

Soft tissue mass destroys the anterior alveolar ridge (with 'floating' tooth). Sclerosis and permeative change compatible with osseous infiltration extends posteriorly through the remainder of the alveolar ridge and most of the hard palate, and superiorly to involve bilateral maxillary sinuses.

Left upper lobe collapse and pleural effusion. 

Histopathology:

MICROSCOPIC DESCRIPTION: Sections of the squamous mucosa show infiltration by poorly differentiated carcinoma. The tumour is about 8mm in depth. It forms sheets and nests with areas of necrosis. No glandular structures are noted. The tumour cells have enlarged pleomorphic nuclei, prominent nucleoli and small amounts of cytoplasm. There is no definite evidence of keratinisation. No evidence of lymphovascular or perineural invasion is seen. The tumour cells are p40 and CK5/6 positive, in keeping with squamous cell carcinoma. Some cells are TTF-1 positive. They are p16, PSA and androgen receptor negative.

DIAGNOSIS: Anterior palate: Poorly differentiated squamous cell carcinoma.

Case Discussion

This patient has a history of metastatic pulmonary squamous cell carcinoma, and the imaging and histopathological features are consistent with metastasis from the lung.

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Case Information

rID: 43223
Case created: 29th Feb 2016
Last edited: 11th Aug 2016
Inclusion in quiz mode: Included

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