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Case Reports
. 2012 Dec;42(4):265-70.
doi: 10.5624/isd.2012.42.4.265. Epub 2012 Dec 23.

Primary intraosseous squamous cell carcinoma mimicking periapical disease: a case report

Yoon-Joo Choi  1 , Song-Hee Oh, Ju-Han Kang, Hwa-Young Choi, Gyu-Tae Kim, Jae-Jung Yu, Yong-Suk Choi, Eui-Hwan Hwang
Affiliations
Case Reports

Primary intraosseous squamous cell carcinoma mimicking periapical disease: a case report

Yoon-Joo Choi et al. Imaging Sci Dent. 2012 Dec.

Abstract

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare carcinoma, which arises within the jaws without connection to the oral mucosa and presumably develops from a remnant of odontogenic epithelium. We present a case of solid type PIOSCC in a 52-year-old male patient complaining of dull pain on his left lower molar. In this case, early stage PIOSCC mimicking a periapical lesion might lead to a one-year delay in treatment due to the misdiagnosis of osteomyelitis after extraction of the third molar. The clinical, radiological, and histologic features are described. In this case, there was initial radiographic evidence for PIOSCC mimicking a periapical lesion. Incautious radiographic interpretation and treatment procedures had delayed the correct diagnosis and resulted in extensive bony destruction during the patient's disease progression.

Keywords: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Mandible; Periapical Disease.

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Figures

Fig. 1
Fig. 1
Cropped panoramic (A) and periapical (B) radiographs show an ill-defined periapical rarefaction coinciding with external root resorption related with the follicular space of the impacted third molar.
Fig. 2
Fig. 2
CBCT images show external root resorption on the distal root and extensive bony lysis over the apex of the second molar from the follicular space of the impacted third molar.
Fig. 3
Fig. 3
CBCT images reveal an extensive and ill-defined bony destruction with the perforation of the buccal and lingual cortical plates.
Fig. 4
Fig. 4
Photomicrographs of the lesion show moderately differentiated squamous cells and solid tumor tissue with cellular atypia and pleomorphism. (H&E stain, A. ×40, B. ×400)
Fig. 5
Fig. 5
Coronal magnetic resonance images show a mass in the left posterior area. A. T1-weighted image shows heterogeneous hypo- to isointensity, B. Contrast-enhanced T1-weighted image, shows a strong heterogeneous enhancement.
Fig. 6
Fig. 6
Axial 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT images show FDG accumulation in the lesion in the left mandible (standardized uptake value; SUVmax=10.9).
See this image and copyright information in PMC

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