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Multiple Cystic Lesions in a Child
DIAGNOSTIC INFORMATION

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
Figure 1. Panoramic radiograph demonstrating bilateral lesions involving the body, angle, and ramus areas of the mandible. Maxillary and mandibular third molar tooth buds, left mandibular canine, mandibular second molars, and right maxillary second molar appear displaced.

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
Figure 3. A low-power photomicrograph (40x) showing a 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
Figure 4. Separation of the epithelium from supporting connective tissue is clearly evident. (100x)

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.

Wavy parakeratin along the surfaces
Figure 5. Wavy parakeratin along the surface, desquamated keratin within the luminal area. (40x)
Wavy parakeratin along the surfaces
Figure 6. Hyperchromatic and palisaded columnar basal cells, are typical features. (200x)