PMC5406791_01
Clinical photograph showing homogenous leukoplakia on the left buccal mucosa before appearance of ulcer
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F1
According to history of presenting illness, the patient was provisionally diagnosed as homogenous leukoplakia with respect to left buccal mucosa 6 months back [Figure 1].
Clinical photograph of the patient showing homogenous leukoplakia with an ulcer after 6 months of initial lesion
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F2
Intraoral soft-tissue examination revealed diffuse, thick, nonscrapable white patch on the left buccal mucosa extending from commissure region up to the retromolar region anteroposteriorly and from the level of the occlusal plane to buccal vestibule superoinferiorly [Figure 2]. A punched out ulcer was seen on the left buccal mucosa approximately 1 cm x 1 cm in size located 1 cm lateral to the commissure of mouth [Figure 2].
Contrast-enhanced computed tomography section showing enhanced and enlarged bilateral cervical lymph nodes (arrow)
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F3
Ib and bilateral upper jugular nodes [Figure 3]. Incisional biopsy was performed from the ulcer.
Photomicrograph (x10) showing dysplastic epithelium with focal area of invasion in underlying connective tissue
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F4
Histopathological sections showed hyperparakeratinized stratified squamous dysplastic epithelium with a focal area of invasion in the underlying connective tissue [Figure 4].
Photomicrograph (x10) showing streaming fascicles of anaplastic spindle cells (arrow)
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F5
The lesional tissue was composed of streaming fascicles of anaplastic spindle cells [Figure 5], which showed marked pleomorphism and strong resemblance to atypical mesenchymal cells.
Photomicrograph (x40) showing marked pleomorphism and strong resemblance to atypical mesenchymal cells with hyperchromatism and altered nuclear-cytoplasmic ratio
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F6
The cells present in the fasciculated pattern were elongated with elliptical nuclei and showed hyperchromatism and altered nuclear-cytoplasmic ratio [Figure 6].
Photomicrograph (x10) showing positive immunohistochemical expression for pancytokeratin in majority of tumor cells and inset (x40) showing cytoplasmic positivity for pancytokeratin (arrow)
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F7
Sections showed that 90% of the tumor cells were positive for pancytokeratin [Figure 7] and 5% of the tumor cells were positive for vimentin [Figure 8].
Photomicrograph (x10) showing positive immunohistochemical expression for vimentin in very few tumor cells and inset (x40) showing cytoplasmic positivity for vimentin
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F8
Sections showed that 90% of the tumor cells were positive for pancytokeratin [Figure 7] and 5% of the tumor cells were positive for vimentin [Figure 8].