PMC9632728_01
Text description: timeline.
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F1
The patient was thereafter referred to the ENT department (See Figure 1 for timeline).
Text description: (A) MRI, T1, sagittal view. ARM marked with red circle. (B) MRI, T2, Axial view. ARM marked with red circle. (C,D) The specimen consisted of nine separate parts which had a diameter of 7 to 38 mm. The surface was well delineated and uniformly brown. The cut surface was solid and light brown with a few, small, darker areas. The surface of the largest tumors was stained blue before sectioning. (E,F) The growth pattern is solid and the tumor cells are large and polygonal with eccentric nuclei and abundant eosinophilic, granular and often vacuolated cytoplasm. The nuclei are rounded and uniform with light staining chromatin and a single nucleolus. Occasionally characteristic striations can be seen in the cytoplasm of the tumor cells. Stained with HE (Hematoxylin-Eosin). The scale bar is set at 100 microm. (G) The tumor cells show a strong cytoplasmic expression of Desmin by immunohistochemical staining, confirming the myogenic origin of the tumor. The scale bar is set at 100 microm. (H) The overall number of tumor cells in the specimen is sparse. The tumor cells are large (compared with adjacent erythrocytes) and have peripherally located nuclei with a single nucleolus and abundant, finely granular cytoplasm. Stained with MGG (Mey-Grunwald-Giemsa). The scale bar is set at 100 microm.
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F2
A fine needle aspiration from one of the tumors showed large, atypical cells resembling RM (See Figure 2H). MRI of the head and neck showed several tumors at the right side of the base of tongue and anteriorly at the base of tongue at the transition to the floor of mouth (see Figures 2A,B). At macroscopic examination the surface of the three largest tumors was alternately smooth and irregular (see Figures 2C,D). On histological examination the tumors showed solid growth of large tumor cells with abundant granular, eosinophilic and vacuolated cytoplasm and occasional cross striations (see Figures 2E-G).
Text description: perioperative photos from the oral cavity showing an incision in the mucosa of the floor of mouth which gives direct contact with one of the RMs marked with a blue circle.
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F3
Subsequently the tumors of the oral floor were completely excised but the tumor in oropharynx was not excised due to the lack of symptoms from this area (see Figure 3).