A rare low-grade myofibroblastic sarcoma in lower jaw with the resemblance to benign lesions.

BACKGROUND: Low-grade myofibroblastic sarcoma (LGMS) is a rare solid infiltrative soft tissue tumor with a predilection for the head and neck region. CASE PRESENTATION: We report the diagnostic steps of a fast-growing lesion of the lower left jaw in a 45-year-old otherwise healthy woman. A first biopsy and subsequent histopathological examination showed potential differentials of a benign myofibroma, benign nodular fasciitis or an LGMS. This diagnostic overlap was a challenge for the decision of the further treatment approach. The treatment consisted of a segmental en bloc resection of the mandible including the second premolar, first and second molar. Histopathological examination of the resected tumor confirmed an LGMS. CONCLUSION: The histopathologic resemblance of LGMS to a range of benign and reactive tumors may lead to misdiagnosis and mistreatment. The rarity of LGMS explains the lack of established treatment protocols. This case shows the importance of adequate clinical decisions, expertise in the histopathology of rare tumors and interdisciplinary exchange to achieve state-of-the-art patient management.

[A radiolucent rarity - primary intraosseous mucoepidermoid carcinoma of the posterior mandible: From radiographic incidental finding to molecular pathological diagnosis]. / Eine radioluzente Rarität ­ Primär intraossäres Mukoepidermoidkarzinom des posterioren Unterkiefers: vom röntgenologischen Zufallsbefund zur molekularpathologischen Diagnose.

We report the case of a 64-year-old patient with incidental finding of a unilocular radiolucency in the posterior mandible on an apical radiograph. The biopsy (cystostomy) revealed the unusual finding of a primary intraosseous mucoepidermoid carcinoma; this is with 2­4% of ectopic manifestations of this entity a rarity. Molecular pathological analysis with a specific panel (SalvGlandDx) and FISH provided diagnosis-confirming evidence of the specific CRTC1-MAML2 fusion. Box resection, prophylactic osteosynthesis using a patient-specific reconstruction plate, neck dissection, and local coverage using a Bichat flap were performed according to the interdisciplinary tumor board decision. With tumor-free lymph nodes and R0 resection, adjuvant therapy was not required. Clinical and imaging follow-up over 24 months showed no evidence of locoregional recurrence. The presented case report emphasizes the central role of private dental practices in the early detection of oral malignancies. These should always be considered in the differential diagnosis of cystic lesions.

The anatomical variability of the sphenoid sinus in CBCT - a retrospective study.

The aim of this retrospective study was to assess and illustrate the anatomical variability of the sphenoid sinus (SPS) on cone-beam computed tomography (CBCT) scans. A total of 50 SPS were assessed. CBCT images were oriented in the sagittal plane to evaluate the type of pneumatization (conchal, presellar, sellar and postsellar). Size measurements (width, length and height) of the SPS as well as the septation pattern and the presence or absence of pathologies were examined in all three planes. The postsellar type (28 cases, 56%) was the most common pattern of pneumatization. Conchal, presellar, or sellar pneumatization were significantly less frequent. There was only one case (2%) with a conchal and two cases (4%) with a presellar type. Multiple septa were found in 75% of patients with postsellar pneumatization, but only in 45.5% of patients featuring conchal, presellar or sellar type. In the postsellar category, all measured dimensions were significantly higher compared to the other types of pneumatization. Pathologies in the SPS were found in 7 patients (14%). It was concluded that the anatomical structure of the SPS is highly variable. Knowledge about its radiological appearance in CBCT will help in identification of pathologies and surrounding anatomical structures.