Multiple Cystic Lesions in a Child

Medical and Dental History

The past medical and dental history to this point was unremarkable. She was asymptomatic and in good general health, had no known drug allergies, and was not taking any medications. The lesions were an incidental finding on the radiographic survey during a routine examination. At the time of examination, no expansion of the jaws was noted.

Radiographic Findings

A panoramic radiograph revealed multiple large, well-defined, multilocular radiolucencies located in each quadrant of the maxilla and mandible. The large multilocular cysts associated with the right and left mandibular molars have smooth corticated margins and involve most of the ascending ramus.

bilateral lesions involving the body, angle, and ramus areas of the mandible

Surgical Findings

Clinical examination of the surgical specimen for the right posterior mandible and right posterior maxilla revealed large rubbery masses of soft tissue resembling deflated cystic structures (Figure 2).  Incompletely formed mandibular molar teeth were included with the surgical sample.

Soft tissue removed
Soft tissue removed
Figure 2. Soft tissue removed from the right (2a) and left (2b) posterior mandible displaying incompletely formed molar teeth and soft tissue resembling collapsed cysts.

Incisional Biopsy Findings

The excisional biopsy specimen shows on histologic examination numerous cystic spaces lined by convoluted, undulating squamous epithelium forming complex cystic spaces (Figure 3). Loose fibrovascular connective tissue surrounds the epithelial lining.

proliferation of squamous epithelium forming complex cystic spaces

Focal areas of the specimen showed the epithelial lining with a complete separation from the supporting connective tissue (Figure 4) which transitions to areas of intact attachment with the connective tissue.

proliferation of squamous epithelium forming complex cystic spaces

A low-power view shows the characteristic wavy, parakeratinized layer surfacing the stratified squamous epithelial lining (Figure 5, 40x) with desquamated keratin seen within the luminal area. A high-power view shows the prominent palisading and hyperchromatic appearance of the tall columnar basal cells (Figure 6, 200x). The epithelial lining can be seen to be six to eight cell layers in thickness.

Wavy parakeratin along the surfaces
Wavy parakeratin along the surfaces