PMC4451676_01
Cervical ganglioneuroma in collision with a metastatic undifferentiated carcinoma. (a) CT head and neck region showing a 3.2 cm mass (arrows) characterized by a central low-signal intensity area suggestive of cystic degeneration. (b) Gross photograph of the left submandibular mass revealing a centrally necrotic and cystic area (arrows). (c and d): Central necrotic area is composed of primitive malignant epithelial cells (H&E stain, (c) x40 and (d) x200). (e) The central tumor cells expressing cytokeratin AE1/AE3 (IHC stain, x200). (f) The peripheral region of the mass contained areas of both primitive malignant cells (arrows) in close association with the ganglioneuronal component (asterisk) (H&E stain, x100). (g) Ganglion and Schwann cells constituted the ganglioneuronal component (H&E stain, x400). (h) The ganglion and Schwann cells show granular expression of chromogranin (IHC stain, x400). (i) Expression of synaptophysin within the ganglion cells (IHC stain, x400)
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F1
Computed tomography (CT) showed a 3.2 x 2.5 x 2.2 cm enhancing mass in the left submandibular area with enlargement of lymph nodes in the cervical neck at levels IIa and IIb and with a radiological impression of metastatic carcinoma involving a cervical lymph node [Figure 1a]. Microscopy revealed two components; an undifferentiated central epithelial component with a second component composed of ganglion and Schwann cells embedded within a neurofibrillary matrix [Figure 1b-i].
Tooth enamel base and gingiva involved by an undifferentiated carcinoma (H&E stain, x40)
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F2
Microscopy demonstrated involvement of the tooth enamel base by an undifferentiated carcinoma [Figure 2].
(a) Primary gingival undifferentiated carcinoma focally in contact with the overlying squamous epithelium (H&E stain, x200). (b) The cells diffusely expressing cytokeratin AE1/AE3 (IHC stain, x100). (c) The malignant epithelial clusters invading the underlying mandibular bone (arrow) (H&E stain, x400)
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F3
There was associated focal dysplasia in the overlying squamous epithelium [Figure 3].