A 4 year old male child presented with a firm, diffuse swelling of the maxilla on left side that had been present for 3 months. The swelling was painless. This had not improved with antibiotics prescribed by a general dental practitioner.
Clinically, the boy was pale with non-palpable non-tender lymph nodes in the submandibular region. Extraoral examination showed a single diffuse swelling of 3 × 4 cm size on left side of the face involving the alveolar part of the maxilla. The margins of swelling were ill defined. There was obliteration of the nasolabial fold and left ala of nose was deviated. The philtrum was slightly deviated to the right side. The skin over swelling was normal and there was no surface pulsation.
Intraorally growth extends both labially and palatally in the region of upper left primary teeth. On the labial side, superiorly it extended upto labial sulcus and inferiorly 3 mm below to the occlusal line. There was slight displacement of upper left primary canine. The palatal aspect showed indentations of mandibular teeth on the swelling. (). The lesion showed bleeding on provocation, consistency was firm and growth was sessile.
Intraoral view of the case showing lesion labially and indentations of mandibular teeth seen on the swelling
The provisional diagnosis of the neoplasm of anterior maxilla are following tumors: Fibrous Sarcoma, Hemangiopericytoma, Chondrosarcoma, Burkitts lymphoma, Malignant peripheral nerve sheath tumor, Thymomas, Osteosarcoma.
A provisional diagnosis of hemangiopericytoma was made and relevant hematological, radiological, biochemical investigations were undertaken confirm the above.
Occlusal radiograph revealed a poorly circumscribed radiolucency involving upper left primary and permanent teeth. Computed Tomography scan scan showed osteolytic lesion involving left maxillary alveolar ridge and soft tissue attentuation measuring upto to 1.2 × 1 cms. ()
Computed Tomography Scan showing osteolytic lesion involving left maxillary alveolar ridge and soft tissue attenuation
Under general anesthesia incisional biopsy of the lesion was performed using monopolar electrocautery. This technique has advantage in obtaining good haemotasis and avoidance of need of sutures.
Lesion showed well circumscribed multiple lobules of tumor mass consisting of tightly packed spindle shaped cells around ramifying walled endothelium lined vascular channels showing a stag horn configuration. ().
Clinical micrograph showing multiple lobules of tumor mass consisting of spindle shaped cells.
Actin was showed positive expression with a diffuse pattern by the tumor cells. () Vimentin was also positive.
Clinical micrograph showing Actin was positive by the tumor cells.
The various investigations showed that the final diagnosis of the lesion is hemangiopericytoma of the anterior maxilla.
The chemotherapy and radiotherapy of lesion was done. No perforation of the cortical plate was noted at the time of treatment. Currently the patient remains well and is under regular review.