PMC6503799_01
(a) Intraorally: Polypoid, pedunculated growth on gingiva, approximately 2.5 cm x 3.5 cm in size and extending on buccal surface in 43-45 region with Grade III mobility of 43, 44. (b) Intraorally: After 15 days, showing increased size of growth with necrotic slough
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F1
A 65-year-old female patient presented with pain and discomfort due to a growth on right mandibular gingiva for 15-20 days, which was rapidly increasing in size [Figure 1]. Intraorally, a polypoid, pedunculated, reddish-pink growth of approximately 2.5 cm x 3.5 cm was seen on gingiva and extending into the alveolar mucosa on buccal surface in 43-45 region [Figure 1].
Intraoral periapical radiograph of 43-44 region showing horizontal bone loss. Widening of lamina dura and mild displacement of 43
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F2
Indentations of opposing teeth were seen on the surface of the growth. Intraoral periapical radiograph of 43-44 region showed widening of lamina dura with mild displacement of 43 and horizontal bone loss [Figure 2].
(a) Spindle-shaped cells and epithelial cells (H&E, x40) (b) Pleomorphic epithelial cells with vesicular nuclei and prominent nucleoli (H&E, x40)
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F3
Two types of cells were seen: one type was of pleomorphic cells with dense hyperchromatic nuclei and dense eosinophilic cytoplasm suggestive of epithelial cells [Figure 3a] and the second type of cells was round to spindle shaped with pale open faced nuclei and prominent nucleoli [Figure 3b].
(a) Immunohistochemistry: Cytokeratin positive (b) Immunohistochemistry: Vimentin positive
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F4
Overall features were suggestive of "high-grade epithelial malignancy." The tumor cells were immunopositive for cytokeratin [Figure 4a] and vimentin [Figure 4b] and were immunonegative for epithelial membrane antigen [Figure 5a], HMB-45 [Figure 5b], CD-34 [Figure 5c] and S-100 protein [Figure 5d].
(a) Immunohistochemistry: Epithelial membrane antigen - negative (b) Immunohistochemistry: HMB-45 - negative (c) Immunohistochemistry: CD-34 - negative (d) Immunohistochemistry: S-100 - negative
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F5
Overall features were suggestive of "high-grade epithelial malignancy." The tumor cells were immunopositive for cytokeratin [Figure 4a] and vimentin [Figure 4b] and were immunonegative for epithelial membrane antigen [Figure 5a], HMB-45 [Figure 5b], CD-34 [Figure 5c] and S-100 protein [Figure 5d].
PMC6503799_02
Intraorally, an irregular, localized growth seen on gingiva extending from 34 to 36 region of approximately 2 cm x 2 cm in size, reddish pink in color, soft in consistency, tender on palpation and bleeding on provocation. 35, 36 - Grade I mobile
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F6
Intraorally, an irregular, localized growth was seen both on buccal and lingual gingiva with ulceration extending from 34 to 36 region of approximately 2 cm x 2 cm in size, reddish pink in color [Figure 6].
Intraoral periapical radiograph shows severe interdental and inter-radicular bone loss in the region of 35, 36
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F7
Radiographically, there was severe interdental and inter-radicular bone loss in the region of 35, 36 [Figure 7].
(a) Highly cellular and vascular tissue with necrotic areas (H&E, x4) (b) Large, pleomorphic cells with hyperchromatic nuclei at periphery and central area of lesion (H&E, x10)
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F8
It showed highly cellular and vascular connective tissue with necrotic areas at periphery on routine H&E [Figure 8a]. The cellular areas comprised large, pleomorphic cells with dense hyperchromatic nuclei and eosinophilic cytoplasm resembling epithelial cells [Figure 8b].
(a) Immunohistochemistry: Cytokeratin positive (b) Immunohistochemistry: Vimentin positive
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F9
The tumor cells were immunopositive for cytokeratin [Figure 9a] with proportionately large number of cells showed vimentin positivity [Figure 9b]. The cells were immunonegative for CD-34 and S-100 protein.