Presentation
Presented to his orthodontist with increased mobility of his left upper teeth.
Patient Data
CT of maxilla low dose "cone beam" technique
There is an expansile lucent lesion within the left maxilla, measuring 30 x 29 x 35 mm AP by TR by CC. It is centered between the permanent left upper canine and first premolar with lobulated margins protruding into the floor of the left nasal cavity, left maxillary sinus, and left hard palate where there are areas of either frank osseous deficiency or extremely thin bone. The remaining osseous margins are sharply defined with nonaggressive borders. Lesional attenuation is misleading on cone beam CT though there is some suggestion that the lesion is more solid than cystic; no discrete lesional calcification/matrix.
No additional osseous lesion is identified within the maxillary field of view.
The lucent maxillary lesion occurs in the setting of a full complement of dentition for age, including partially erupted third molars. There is splaying apart of the roots of the first maxillary canine and premolar by the lucent lesion. There is otherwise normal alignment within each dental arch. There is normal molar occlusion and overjet/overbite. The temporomandibular joint is normally positioned.
There is protrusion of the lytic maxillary lesion into the left nasal cavity, left maxillary sinus, and left hard palate. The visualized nasal cavity and paranasal sinuses are otherwise clear.
Soft tissue structures of the face are not diagnostically evaluated due to low-dose technique.
Case Discussion
Moderate sized lucent lesion within the left maxilla, splaying apart the left permanent canine and first premolar with protrusion into adjacent structures (left nasal cavity, left maxillary sinus, and left hard palate). There is limited characterization of this lesion by cone beam CT, but the appearance is suggestive of a benign neoplasm (solid) or cyst: giant cell granuloma, adenomatoid odontogenic tumor, keratocystic odontogenic tumor, Langerhans cell histiocytosis, simple bone cyst, and aneurysmal bone cyst are among the differential considerations. Definitive diagnosis will require biopsy, but preoperative MRI could provide further tissue characterization if indicated.
Subsequent biopsy confirmed the lesion to be a giant cell tumor and the lesion was treated with surgical enucleation.
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