PMC4065458_01
Extraoral photograph showing swellings in the left cheek and neck region
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F1
Skin over the swellings was stretched without any secondary changes but was tender on palpation [Figure 1].
(a) Compurted tomography scan image showing a mass from the left buccal mucosa extending to the retromolar trigone and involving the submandibular region of the same side. (b) Computed tomography scan picture showing lesion infiltrating mandible
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F2
Erosion of the alveolar ridge in 36 and 37 region with tooth displacement was also seen [Figure 2].
Macroscopic photograph of the submitted excised specimen. Inset showing cut surface of submandibular gland
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F3
The excised radical neck dissection specimen was submitted to us for histopathological evaluation [Figure 3].
Photomicrograph showing various patterns. (a) Organoid (H&E stain, x100), (b) microcystic (H&E stain, x40), (c) follicular (H&E stain, x40) and (d) papillary cystic (H&E stain, x40)
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F4
Among the various patterns observed like microcystic, follicular, organoid and papillary cystic; the organoid pattern predominated [Figure 4].
Photomicrograph showing features of High grade transformation. (a) Increased typical and atypical mitosis (H&E stain, x400), (b) Comedonecrosis (H&E stain, x200), (c) Tumor invasion into the vessels (H&E stain, x400), (d) Nodal tissue replaced by tumor cells (H&E stain, x200), (e) Photomicrograph showing few
cells positive to cyclin D1 (IHC stain, x400) and (f) Tumor invasion into the bone (H&E stain, x100). Inset showing tumor cells at higher magnification (H&E stain, x400)
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F5
Few areas showed frequent mitosis and tumor necrosis and tumor cells invading the vessels [Figure 5a-c]. Histopathological typing of the submandibular lymph nodes revealed replacement of the normal tissue by intercalated duct-like cells, few arranged in solid pattern and majority in follicular pattern [Figure 5d]. Invasion of the tumor cells into the bone was also evident [Figure 5f].
(a) Photomicrograph showing section stained with periodic acid-Schiff and treated with diastase (PAS with diastase digestion stain, x200). (b) Electron microscopic picture showing electron dense secretory granules (G) adjacent to the nucleus (N) of serous acinar cell
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F6
Demonstration of the diastase-resistant periodic acid-Schiff-positive serous cells in the sections was subtle [Figure 6a]. Though negligible in number, the electron microscopy picture could clearly reveal the serous acinar cells with electron dense secretory granules [Figure 6b].