PMC4860927_01
Intraoral photograph showing diffuse ulceroproliferative growth on the left alveolar mucosa in the third molar region
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F1
Intraoral examination revealed a diffuse ulceroproliferative growth on the left alveolar mucosa in the third molar region of size approximately 4 cm x 3 cm extending anteroposteriorly from distal aspect of the 25 to maxillary tuberosity and mediolaterally 4 mm away from the midline of the palate and laterally encroaching the vestibule [Figure 1].
(a) Intraoral periapical radiograph shows well-defined radiolucency with irregular border (arrow) in relation to 25 and the alveolar ridge irt 26, 27 region shows diffuse rarefactions (arrowhead) around the surrounding bone. (b) Occlusal radiograph showing well-defined radiolucency (arrow) in the left alveolar ridge in relation to 26 and 27
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F2
Intraoral periapical radiograph irt 25, 26, 27 shows well-defined radiolucency with irregular border and on the alveolar ridge irt 26, 27 shows diffuse rarefactions surrounding the bone [Figure 2a]. Maxillary occlusal radiograph shows a well-defined radiolucent bony defect in the left posterior region of palate in relation to 26 and 27 [Figure 2b].
Spiral computed tomography showed a soft density lesion involving alveolar process of the left maxilla which is extending into the adjacent pharyngeal mucosal space
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F3
Spiral computed tomography showed a soft density lesion measuring 5 cm x 3.5 cm involving alveolar process of the left maxilla and extending into the adjacent pharyngeal mucosal space [Figure 3].
(a) Photomicrograph showing tumor cells with a thin rim of cytoplasm and few cells with clear cytoplasm arranged in pseudoalveolar pattern (H&E stain, x40). (b) Photomicrograph showing large uninucleated cells with eosinophilic cytoplasm (H&E stain, x200)
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F4
Microscopic examination showed round cells with large nucleus, a thin rim of eosinophilic cytoplasm with prominent nucleoli and few cells with clear cytoplasm arranged in pseudo alveolar pattern with central discohesive floating cells [Figure 4a and b].
(a) Photomicrograph showing cytoplasm of tumor cells to be positive for positivity with phosphotungstic acid hematoxylin (PTAH stain, x100). (b) High power view showing positivity for Masson trichrome with the cytoplasm of the cells taking up the red stain (Masson trichrome stain, x100)
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F5
The cytoplasm of tumor cells showed positive staining with phosphotungstic acid hematoxylin (PTAH) and Masson trichrome [Figure 5a and b].
(a) Photomicrograph showing strap cells positive for phosphotungstic acid hematoxylin stain (PTAH stain, x400) (b) Photomicrograph showing tumor cells to be positive for vimentin (IHC stain, x100)
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F6
Few strap cells showed PTAH positive staining with no evidence of cross striations [Figure 6a]. For confirmatory diagnosis panel of immunohistochemical markers was done and the tumor cells showed strong positivity for vimentin [Figure 6b] and Myo-D [Figure 7a] and were negative for epithelial membrane antigen [Figure 7b] and S-100, [Figure 7c].
(a) Photomicrograph showing tumor cells to be positive for Myo-D (IHC stain,x200). (b) Photomicrograph showing tumor cells being negative for epithelial membrane antigen (IHC stain, x100). (c) Photomicrograph showing tumor cells to be negative for S-100 (IHC stain, x200)
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F7
For confirmatory diagnosis panel of immunohistochemical markers was done and the tumor cells showed strong positivity for vimentin [Figure 6b] and Myo-D [Figure 7a] and were negative for epithelial membrane antigen [Figure 7b] and S-100, [Figure 7c].