PMC6396626_01
Extraorally (a), an ill-defined swelling extending from the malar region upto the inferior border of the mandible on the left side (short black arrows) was seen. Intra-orally (b), an irregular exophytic growth (green arrows) was present in the left retromolar trigone region distal to 26, causing vestibular obliteration, and a diffuse swelling (white arrow) in the adjoining posterior buccal mucosa. The deepest part of the growth opposite 38 was laden with food deposit (yellow arrow)
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F1
Extraorally [Figure 1a], it extended from the malar region up to the inferior border of the mandible on the left side, measuring approximately 3 cm x 4 cm in dimension and causing gross facial asymmetry with considerable trismus. Intraorally [Figure 1b], there was an irregular exophytic growth present in the left retromolar trigone region distal to 26, causing vestibular obliteration, and a diffuse swelling in the adjoining posterior buccal mucosa.
OPG revealed extensive destruction of the alveolar process of maxilla distal to 26 (black arrow) and anterior border of the ramus (white arrows) of the mandible (a). PNS View showed complete opacification of the left maxillary sinus (star). Destruction of the postero-lateral wall was seen on the left side (red arrows) as opposed to the contralateral normal side (yellow arrows) (b)
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F2
Orthopantomogram revealed extensive destruction of the alveolar process of maxilla distal to 26 and anterior border of the ramus of the mandible [Figure 2a]. Paranasal sinus view showed complete opacification of the left maxillary sinus with destruction of its posterolateral wall [Figure 2b].
Ultrasonogram revealed a hyperechoic, thick-walled, soft tissue mass (black arrows) with a central hypoechoic paisley-shaped, fluid-filled area (yellow star) below the zygomatic arch, occupying the buccal and masseteric regions
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F3
Ultrasonography [Figure 3] revealed a thick-walled soft tissue mass with central fluid-filled space occupying the left nasolabial, buccal, and masseteric regions.
Coronal (a) and axial (b) sections of contrast-enhanced T2W MRI revealed hyperintense, soft-tissue mass with central necrosis, epicentre of the mass being left masticator space (yellow star). Left masseter and buccal spaces were involved alongwith pterygoid muscles with erosion of the ramus of the mandible (1,2, and 3 represent the normal masseteric and buccal spaces, and pterygoid muscles on the contralateral right side). Mass compressing the left maxillary antrum (4) seen with smooth scalloping of its wall
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F4
MRI [Figure 4a and b] revealed a well-defined, irregular-shaped soft-tissue mass with central necrosis, epicenter of the mass being left masticator space.
Intensely hematoxiphilic nucleated spindle cells arranged parallel in a palisading manner around Verocay bodies (black arrows; a: x40) suggestive of Antoni A tissue (black dots), and oedematous connective tissue stroma, dilated capillaries (green arrow), and streams of loosely packed spindle cells in the interstitium, suggestive of Antoni B type tissue (white dots; b: x10)
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F5
Histopathological examination revealed intensely hematoxiphilic nucleated spindle cells arranged parallel in a palisading manner around Verocay bodies, suggestive of Antoni A tissue [Figure 5a: 40x], and edematous connective tissue stroma, dilated capillaries, and streams of loosely packed spindle cells in the interstitium, suggestive of Antoni B type tissue [Figure 5b: 10x], overall confirming the diagnosis of schwannoma.