Odontogenic myxoma with diffuse calcifications: a case report and review of the literature

Abstract

This is a case report of an unusual odontogenic myxoma with calcifications, one of three reported in the literature. It had a typical radiographic appearance although it presented in an older patient. The presence of osteo-cementum-like calcification raises other differential diagnoses but does not in and of itself mitigate the diagnosis. The patient has not shown recurrence 14 months after resection and 11 months after reconstruction and continues to be closely monitored.

Fig. 1

Panoramic radiograph showing “tennis racket” appearance of bone around the roots of teeth #30 and #31 with intact inferior border cortex (Courtesy of Dr. Toby Feldman, private practice, Cambridge, MA)

Fig. 2

Periapical radiograph from 19 years prior to presentation demonstrating delicate honeycomb appearance (Courtesy of Dr. John Boyle, general practice, Lexington, MA)

Fig. 3

Axial view of mandibular CT demonstrating expansile, lytic lesion containing delicate radiopacities

Fig. 4

Photomicrograph of initial biopsy showing delicately collagenized myxoid tissue with spindle cells and large and small calcifications (Hematoxylin-eosin, magnification ×100)

Fig. 5

a Resected right mandible. b Gross specimen radiograph showing anterior margin to be free of tumor

Fig. 6

a Photomicrograph showing tumor permeating bone and abutting the root of a tooth (arrow) (Hematoxylin-eosin; magnification ×20). b Photomicrograph showing pseudocystic change within tumor (Hematoxylin-eosin; magnification ×100). c Photomicrograph showing benign nature of the spindled and stellate cells in mucinous stroma (Hematoxylin-eosin; magnification ×400). d Photomicrograph showing hematoxyphilic calcifications resembling cementum fused with residual bone trabeculae (Hematoxylin-eosin; magnification ×100). e Photomicrograph showing spherules of dysplastic cementum with peripheral radiating collagen fibers suggestive of Sharpey fibers (Hematoxylin-eosin; magnification ×100). f Photomicrograph with polarized light comparing sweeping lamellae in residual lamellar bone compared to the short fibers in the osteo-cementum (Hematoxylin-eosin; magnification ×200)