PMC3303532_01
Clinical photograph showing swelling on the palate
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F1
Intraoral examination exhibited a firm, exophytic, oval mass with an intact overlying mucosa in the region of the right hard palate measuring 3 x 4.5 cm in size [Figure 1].
Computed tomography scan of patient
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F2
CT scan revealed a mass on the right side of the hard palate, with no involvement of the maxillary sinus [Figure 2].
Photograph of gross excisional tissue
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F3
An excisional biopsy [Figure 3] was performed under local anesthesia. and a bony crater-like defect was seen on the palatal bone after soft tissue removal.
(a) The overlying epithelium is seen separated from follicles. The histological picture in this view gives the impression of reactive follicular hyperplasia of the lymphoid tissue (H and E, stain; original magnification, x2.5). (b) High-power view of the follicular pattern gives the impression of a reactive lesion (H and E, stain; original magnification, x10)
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F4
Histopathological examination of sections of the resected specimen revealed an intact stratified squamous epithelium with underlying vaguely follicular and diffuse proliferation of lymphoid cells [Figure 4a and b].
Magnified view showing central larger cells with mitotic figures, convoluted nuclei, and inconspicuous nucleoli. Peripherally, small round lymphocytes are seen (H and E, stain; original magnification, x20)
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F5
The central large cells had abundant pinkish cytoplasm and convoluted nuclei with inconspicuous nucleoli [Figure 5].
The large lymphoid cells show positive immunoreactivity for CD20, whereas the peripheral small lymphocytes are negative. Inset shows control stain (original magnification, x10)
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F6
The large lymphoid cells showed immunoreactivity for CD20 and the rim of small lymphocytes were positive for CD5 [Figure 6].
The peripheral small lymphocytes show positive immunoreactivity for CD5, whereas the central large cells are negative. Inset shows control stain (original magnification, x10)
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F7
The large lymphoid cells were negative for CD5, Bcl-2, and CD10 [Figures 7-9].
The peripheral small lymphocytes show positive immunoreactivity for Bcl2, whereas the central large cells are negative. Inset shows control stain (original magnification, x10)
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F8
The large lymphoid cells were negative for CD5, Bcl-2, and CD10 [Figures 7-9].
Negative immunoreactivity for CD10 (original magnification, x10)
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F9
The large lymphoid cells were negative for CD5, Bcl-2, and CD10 [Figures 7-9].
Immunohistochemistry profile showing very low Ki67 proliferative index (original magnification, x20)
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F10
The Ki67 proliferative index was 1% [Figure 10].