PMC7269315_01
Intraoral clinical images a and b, showing pyogenic granuloma of gingiva involving the lower right mandibular region. Image c showing squamous cell carcinoma of the left buccal mucosa
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F1
Oral biopsies were taken, one from the gingival region with respect to 33-35 having smooth surface and reddish pink in color and nontender from a 30-year-old female patient [Figure 1a], and another biopsy was taken from a 32-year-old male patient, where the lesion was soft to firm in consistency, was light pink in color and surrounding the attrited right incisor tooth region [Figure 1b]. The third biopsy was taken from a 62-year-old male patient [Figure 1c] with respect to the left buccal mucosa in relation to the maxillary and mandibular molar tooth region having both white and erythematous ulcerative areas, which was tender on palpation.
Incisional biopsy photographs a and b, gross specimen of pyogenic granuloma measuring about 1x1.2 cm, 1x1 cm. (c) gross specimen of squamous cell carcinoma measuring about 1.2x1 cm with soft to firm consistency along with irregular surface and margin
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F2
On incisional biopsy, the first soft-tissue specimen was measuring about 1 cm x 1.2 cm, was soft to firm in consistency, was creamish in color, had an irregular surface and margin and was roughly oval in shape [Figure 2a]. The second gross specimen was measuring about 1 cm x 1 cm, was soft to firm in consistency and was cream to brown in color with an irregular surface [Figure 2b]. The third soft-tissue specimen was measuring about 1.2 cm x 1 cm, was cream to dark brown in color with an irregular surface and had rolled-out margin [Figure 2c].
a and b, H&E stained pictures showing parakeratinized stratified squamous epithelium overlying the connective tissue components and clusters of eosinophilic toto bodies in the upper spinous cell layer (10x)
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F3
a and b, underlying connective tissue shows the presence of haphazardly arranged collagen fibers bundles, numerous large endothelial lined blood capillaries with RBC'S and mild to moderate chronic inflammatory cell infiltrate (4x)
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F4
The underlying connective tissue of both the cases [Figure 4a and b] showed the presence of haphazardly arranged collagen fiber bundles, numerous large endothelial lined blood capillaries with red blood cells and mild-to-moderate chronic inflammatory cell infiltrates.
H&E picture showing the presence of nonkeratinized stratified squamous epithelium showing areas of eosinophilic Toto bodies (10x)
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F5
H&E-stained picture showing hyperplastic epithelium and superficially confined Toto bodies with few focal areas showing a break in the continuity of the basement membrane (black arrow). Subepithelial connective tissue is composed of severe inflammatory cell response mainly composed of lymphocytes and plasma cells (4x)
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F6
Toto bodies. The epithelium was hyperplastic in nature and had superficially confined Toto bodies with few focal areas showing a break in the continuity of the basement membrane (shown with black arrow). The subepithelial connective tissue was composed of severe inflammatory cell response mainly composed of lymphocytes and plasma cells [Figure 6].
H&E-stained picture showing that the deeper connective tissue is composed of moderately differentiated epithelial cell population arranged in the form of sheets and cords and presenting dysplastic epithelial cells with nuclear and cellular pleomorphism (black arrow) and nuclear hyperchromatism (arrowhead) (20x)
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F7
Dysplastic epithelial cells within the connective tissue showed features of dysplasia such as nuclear and cellular pleomorphism (black arrow) and nuclear hyperchromatism (arrowhead) [Figure 7].