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A Mass of the Maxillary Tuberosity

Case Challenge Number: 48

Diagnostic Information

History of Present Illness

The patient presented for a routine dental examination whereupon a bony expansion of the right maxillary tuberosity was noted. The patient was asymptomatic and could not recall how long it had been present.

Medical and Dental History

The patient had a history of seasonal allergies and was taking vitamin supplements for anemia, but was not taking any other medications, nor was she under care for any other systemic conditions. The dental history, though not extensive, included a history of extraction in the area of concern.

Clinical Findings

Clinical examination revealed a large, bony hard expansion of the right posterior maxilla that measured approximately 4.0 cm × 3.0 cm × 1.5 cm and extended slightly into the maxillary vestibule (Figure 1). The mucosa was of normal coloration with no areas of ulceration or alteration. The remainder of the oral cavity was without obvious disease and did not reveal masses such as that seen in the right posterior maxilla.

Figure 1.A. An expansile mass of the right posterior maxilla. B. Note the extension of the lesion beginning to involve the maxillary vestibule.

Radiographic Findings

A panoramic radiograph (Figure 2) revealed a fairly well-circumscribed mass of the right posterior maxilla encompassing the posterior alveolar crest and the maxillary tuberosity.  The lesion displayed a variable degree of radiodensity.  The central portion of the mass exhibited a prominent radiodensity that, at its periphery, blended into the outer margins of the lesion producing a mixed radiodense pattern.

Figure 2.A. Panoramic radiograph depicting a well-defined mixed density with a central area of increased opacification. B. Close-up view of the lesion.

Surgical Findings

Upon flap reflection, an exophytic expansion of bone with a broad base was encountered visually.  The lesional tissue appeared to be demarcated from the surrounding bone, and easily separated from the bone upon surgical manipulation (Figure 3).

Figure 3. Flap reflection reveals a broad-based expansion of bone that was demarcated from the surrounding bone upon surgical incison.

Incisional Biopsy Findings

On incisional biopsy, a thin rim of cortical bone was present peripherally (Figure 4).

Figure 4. A low-power (200x) photomicrograph showing a thin rim of cortical bone surrounding bony islands and single bony trabeculae.

The lesional tissue consisted of rounded islands and trabeculae of bone within a highly cellular stroma of spindled to plump cells (Figure 5). Areas of cementum-like product were seen in addition to the bony product (Figure 6).

Figures 5 and 6. The highly cellular and storiform stroma contains islands of intermixed bony and cementum-like calcifications that have a thin, fibrillar border. (Figure 5: 200x magnification; Figure 6: 400x magnification.)