The CT and MRI results from Tuesday are in.
They are not good.
We have a telephone conference tonight with Dr P and they are scheduling me for a second biopsy on Saturday afternoon.
They need to find out more than the MRI can show them. They need to exclude malignancy.
The next step might be a CT PET scan to determine whether my ameloblastoma is in fact cancer.
Read on below if you can. We hope Dr P can explain it tonight.
Report: There is an expansile unilocular lesion involving the posterior left mandible and ramus. The second and third left mandibular molars are absent. There is no evidence of an unerupted tooth. The mandibular canal is displaced inferiorly and its roof is dehiscent. There is thin remodelled bone peripherally with areas of focal dehiscence through the buccal and lingual cortex and inferior border of the mandible. There is periosteal reaction seen anteroinferiorly over the buccal cortex. No osteoid matrix is present. Extraosseous extension is better demonstrated on the MRI performed today. No other bone lesions are seen.
Conclusion: There is an expansile lesion within the posterior left mandibular body and ramus, consistent with the histological diagnosis. There is extension through the cortex into the soft tissues. The periosteal reaction is atypical and may represent secondary infection. A malignant ameloblastoma should also be considered.
Report: There is a expansile mass involving the posterior left mandible body and ramus. The mass is largely isointense to muscle on T1 and slightly hyperintense on T2. Centrally there is an area measuring of T11T2 hyperintensity.The mass demonstrates avid enhancement, with a small central non enhancing component measuring 8mm.
There is dehiscence of the buccal conex medially and the lesion extends into the submandibular space abutting the mylohyoid muscle. There is periosteal reacti0n anteriorly over the lingual cortex and the mass extends through the cortex and perlosteum, buccal gingival sulcus and buccinator msucle. The mass surrounds the facial artery and is limited faterally by the facial muscles. There is edema and enhancement seen around the anteror border of the masseter muscle.
Posteriorly there is involvement of the mandibular ramus and the lesion abuts the anterior border of the medial pterygoid muscle. Inferiorly the inferior areolar canal is dehiscent and displaced. The tumor breaches the lower border of the mandible to project into the submandibular space.
There is normal fat within the pterygoid palatine fossa. There is no evidence of perineural tumour spread along the trigeminal nerve. There is no denervation of the muscles of mastication. There is a left retropharyngeal lymph node measuring 6mm. There are non enlarged lymph nodes in level 1B.
Conclusion: There is an enhancing mass within molar ramus region of the left hemi-mandible, corresponding to the the histologically diagnosed ameloblastoma. There is extraosseus extension into the soft tissues as described and inferior displacment and dehiscence of the inferior alveolar canal. Periosteal reaction is an atypical finding and may indicate secondary infection. Infection could account for some of the soft tissue changes laterally. A malignant ameloblastoma should also be considered.