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Dolphine Oda, BDS, MSD
Contributed by Drs. Mark Carlson, Galya Pirinjian
Tacoma Oral Surgery and University of Washington

History of Present Illness
A 60-year-old white male who is evaluated severe and localized bone loss in the upper right posterior maxilla.
Medical History
The medical history is significant for hypertension and hypercholesterolemia. The patient has no known drug allergies. The patient had a CAT scan done in June 2003 for symptoms of pneumonia and possible sepsis (not shown). He also had CT of the head, chest, abdomen, and pelvis, in an attempt to diagnose the etiology of the pneumonia. The radiologist noticed an expansile intermediate-density mass in the right posterior maxilla, causing bony destruction and extending inferiorly into the maxillary sinus, measuring 2.5 X 2.1 cm in greatest dimensions.
Clinical & Radiographic Findings
The clinical examination showed an area of severe and localized bone loss in the right posterior maxilla simulating localized periodontitis which lead to the extraction of tooth #2. At extraction, the dentist noticed that the bony consistency was soft and spongy combined with extensive bone loss involving the posterior maxilla and the inferior and posterior portions of the maxillary sinus (Fig 1). The Oral Surgeon also noticed bony expansion in addition to the extensive destruction. The bony destruction at that point was measured to be approximately 3 ¼ x 2 ½ cm in greatest dimensions (Fig 1).

Figure 1. Panoramic view of the presentation in Dec 03 demonstrating destructive radiolucency involving the right posterior second molar tooth, distal bone and the maxillary sinus.
Incisional Biopsy
Histologic examination revealed a solid and benign neoplasm of odontogenic epithelial origin made up of a combination of epithelial islands and cords (Fig 3, 4). The periphery of the islands is lined by columnar or cuboidal and palisaded epithelial cells (Fig 4) and the center of the islands is filled with cuboidal and stellate epithelial cells consistent with stellate reticulum. The epithelial cords are long and are forming a network of two-layers of cuboidal and palisaded epithelial cells. These epithelial islands are suspended on a background of loose and vascular connective tissue.