This 14 year old girl complained of a sudden increase in the size of the left side of her jaw over the last several months. According to her mother, the patient had grown six inches within the last year and had begun her menses. All other medical findings, including a bone survey and alkaline phosphatase, were negative. X-rays of the jaws revealed a diffuse enlargement of the left mandible with increased opacity and "fuzziness" to the bone. Tooth #20 was found to be nonvital, probably accounting for the periapical pathosis.
Differential Diagnosis:
Fibrous Dysplasia
Osteogenic Sarcoma
The ground glass appearance of the bone is compatible with a diagnosis of fibrous dysplasia and these lesions may exhibit growth with the onset of puberty.
Histology:
Slide 1 (medium power, H&E). There are variously sized and shaped osteoid deposits immersed within cellular fibroblastic-like connective tissue. (The spaces between the bone and connective tissue are due to artefactual separation during microtome cutting of the tissue.)
Slide 2 (high power, H&E). There are small deposits of osteoid with little, if any, osteoblastic rimming. Nuclei of the fibrous tissue are ovoid and uniform.
Differential Diagnosis:
Slide 1 (medium power, H&E). There are variously sized and shaped osteoid deposits immersed within cellular fibroblastic-like connective tissue. (The spaces between the bone and connective tissue are due to artefactual separation during microtome cutting of the tissue.)
Slide 2 (high power, H&E). There are small deposits of osteoid with little, if any, osteoblastic rimming. Nuclei of the fibrous tissue are ovoid and uniform.