Answer for BIR CoW 11 May 2025
Xanthoma of Mandible
Findings
Relatively well defined expansile lytic lesion with septation and cortical fragmentation noted involving the body and ramus of the right mandible No evidence of resorption of teeth noted
Differential Diagnosis : Odantogenic tumours like ameloblastoma Cementoma ossifying fibroma Odantoma
Discussion
Gnathic bone xanthomas are mostly asymptomatic and are incidental findings on routine dental radiography. They have a wide age distribution ranging from 11 to 72 years with the majority presenting in the second and third decade of life . The mandible is more commonly affected than the maxilla with a ratio of 9:1. Mandibular xanthomas are largely asymptomatic and are often solitary There is high variability in their radiographic appearance. In the mandible, xanthomas are usually small and range 1 to 4 centimetres in size Internal features have varied from totally radiolucent to a mixed appearance with ‘honey-combing’. The peripheral appearance of these lesions also varies, with descriptors of corticated, scalloped, ill-defined, and slightly sclerotic margins Root resorption and displacement of the inferior alveolar canal has been reported in a small number of cases but largely they do not influence surrounding structures Histologically, primary xanthomas and aggregates of foamy histiocytes or foam cells and may or may not have an associated chronic inflammatory cellular response that immunohistochemically stain positive for CD68, CD 163 Our case revealed the similar histo pathology and was CD68 positive
Reference: Saha A, Tocaciu S, Subramanian B, Primary Xanthoma of Mandible – A case report, Journal of Oral and Maxillofacial Surgery (2017), doi: 10.1016/j.joms.2017.10.009 Jason P. Jones, Angela M. Hoikka, Felix Jose Amarista, Daniel E. Perez,Primary intraosseous xanthoma of the mandible – A case report, novel approach to removal, and review of the literature
Findings
Relatively well defined expansile lytic lesion with septation and cortical fragmentation noted involving the body and ramus of the right mandible No evidence of resorption of teeth noted
Differential Diagnosis : Odantogenic tumours like ameloblastoma Cementoma ossifying fibroma Odantoma
Discussion
Gnathic bone xanthomas are mostly asymptomatic and are incidental findings on routine dental radiography. They have a wide age distribution ranging from 11 to 72 years with the majority presenting in the second and third decade of life . The mandible is more commonly affected than the maxilla with a ratio of 9:1. Mandibular xanthomas are largely asymptomatic and are often solitary There is high variability in their radiographic appearance. In the mandible, xanthomas are usually small and range 1 to 4 centimetres in size Internal features have varied from totally radiolucent to a mixed appearance with ‘honey-combing’. The peripheral appearance of these lesions also varies, with descriptors of corticated, scalloped, ill-defined, and slightly sclerotic margins Root resorption and displacement of the inferior alveolar canal has been reported in a small number of cases but largely they do not influence surrounding structures Histologically, primary xanthomas and aggregates of foamy histiocytes or foam cells and may or may not have an associated chronic inflammatory cellular response that immunohistochemically stain positive for CD68, CD 163 Our case revealed the similar histo pathology and was CD68 positive
Reference: Saha A, Tocaciu S, Subramanian B, Primary Xanthoma of Mandible – A case report, Journal of Oral and Maxillofacial Surgery (2017), doi: 10.1016/j.joms.2017.10.009 Jason P. Jones, Angela M. Hoikka, Felix Jose Amarista, Daniel E. Perez,Primary intraosseous xanthoma of the mandible – A case report, novel approach to removal, and review of the literature
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!