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This 44 year old female was treated over a course of one year for a symptomatic mandibular left second bicuspid. Due to extensive bone loss and severe mobility of the tooth, a biopsy was performed along with extraction of the involved tooth.

Differential Diagnosis:

  1. Eosinophilic Granuloma
  2. Squamous Odontogenic Tumor
  3. Ameloblastoma
  4. Calcifying Odontogenic Cyst
Although the lesion is fairly well demarcated, there is no clear cut delineation, such as a sclerotic border, from the adjacent bone. Also note that this is predominantly an alveolar bone process.


Slide 1 (medium power, H&E). This slide shows a dense cellular infiltrate. The cells contain lightly staining cytoplasm and uniform round or indented nuclei.

Slide 2 (high power, H&E). This slide demonstrates collections of cells with granular eosinophilic cytoplasm and bilobed nuclei. Although difficult to see, these eosinophils are found within a background of the larger mononuclear cells.

Diagnosis: Eosinophilic Granuloma

Note: any form of Langerhans cell disease (Histiocytosis X) could have this type of histology.