Head & Neck Case Review 2020-08

Head & Neck Case Review

August, 2020


A 30 year old patient presented with a pathologic mandible fracture and loose teeth following minimal trauma. CT imaging revealed a thin mandibular body and ramus with superimposed areas of permeative destruction and erosion, and a minimally displaced fracture of the mandibular angle. The ipsilateral maxillary sinus appeared hypoplastic. A segmental mandibulectomy with reconstruction was performed. The disease progressed within one year requiring total mandibulectomy and prosthetic replacement.


Maxilla (left) / Mandible (right)

Virtual Slide



Q1. What is the diagnosis

  • A. Paget disease
  • B. Gorham-Stout disease
  • C. Angiosarcoma
  • D. Fibrous dysplasia

Q2. What are the characteristic histologic features?

  • A. Malignant lymphatic or vascular proliferation involving bone
  • B. Benign lymphatic or vascular proliferation and osteolysis
  • C. Cystic spaces lined by fibrous tissue with osteoclast-like giant cells
  • D. Osteonecrosis with a reactive lymphatic or vascular proliferation



Manuel Lora Gonzalez, MD
Selective Surgical Pathology (Head and Neck) Fellow, PGY-6
Department of Pathology and Immunology
Washington University in St. Louis