Radiological Case: Odontogenic Ghost Cell Carcinoma

Robert Crowder, MD; Scott A Jorgensen, MD; Alexander J Towbin, MD; Richard Towbin, MD

Disclosures

Appl Radiol. 2020;49(4):42-43. 

In This Article

Imaging Findings

Radiographs obtained by the patient's dentist demonstrated a right maxillary lytic lesion. Axial soft tissue and bone algorithm CT images demonstrated a lytic, soft-tissue-attenuating mass arising from the alveolar process of the right maxilla, with destruction of the buccal and lingual cortices (Figure 1). Tumor extension into the right buccal space, as well as into the hard palate, were also demonstrated. No significant periosteal reaction was identified.

Figure 1.

(A) Axial soft tissue and (B) bone algorithm CT images demonstrate a lytic, soft-tissue attenuating mass arising from the alveolar process of the right maxilla with destruction of the buccal and lingual cortices (arrows). The tumor extends into the right buccal space as well as the hard palate. No significant periosteal reaction is identified.

Coronal CT image viewed in bone window and a volume-rendered 3D image viewed in the RAO projection showed destruction of the maxillary alveolar process with dehiscence of the right maxillary sinus floor (Figure 2). Multiple maxillary teeth were displaced, with root resorption. Coronal and axial CT images obtained 5 weeks later, following partial resection and extraction of involved maxillary teeth, showed significant mass enlargement, with large exophytic components extending into the adjacent buccal space and oral cavity near the hard palate (Figure 3).

Figure 2.

(A) Coronal CT image viewed in bone window and volume-rendered 3D image viewed in the RAO projection. Images show destruction of the maxillary alveolar process with dehiscence of the right maxillary sinus floor (red arrows). (B) There is displacement of multiple maxillary teeth (green arrows) with root resorption (blue arrow).

Figure 3.

(A) Coronal and (B) axial CT images obtained just 5 weeks later following partial resection and extraction of involved maxillary teeth shows significant progression of the mass in the interim with large exophytic components extending into the adjacent buccal space and oral cavity, encroaching upon the hard palate (arrows).

Axial and coronal magnetic resonance imaging (MRI) showed this mass to be predominantly solid and T2 hyperintense to muscle, with some small cystic components (Figure 4). Postcontrast axial T1 images showed avid contrast enhancement, as well as large, partially necrotic level 1B lymph node metastases (Figure 5).

Figure 4.

(A) Axial T2 and (B) coronal T2 images show this mass to be predominantly solid, T2 hyperintense to muscle, with some small cystic components (arrow).

Figure 5.

Postcontrast image at the level of the submandibular gland demonstrates large, partially necrotic level 1B lymph node metastases (red arrow). A suspicious right level 2B node is also visualized (blue arrow).

Axial PET/CT imaging demonstrated significant hypermetabolism within the mass, maximum SUV 12.1 (Figure 6).

Figure 6.

Axial PET/CT image demonstrates significant hypermetabolism within the mass with maximum SUV 12.1 (arrows).

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