PMC6754833_01
A) intraoral photograph showing well defined solitary swelling in right buccal mucosa; B) CECT showing heterogeneously enhancing lobulated soft tissue lesion in the right masticator space between masseter and pterygoid muscle (arrows)
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On intraoral examination, the swelling was soft to firm in consistency, mobile, non-fluctuant, non-pulsatile, non-tender, and was mobile in all planes (Figure 1 A). Computed tomography (CT) scan of maxilla and mandible revealed heterogeneously enhancing, lobulated soft tissue lesion, measuring 3.3 X 1.78cm in the right masticator space between masseter and pterygoid muscle causing obliteration of retro-maxillary fat (Figure 1 B).
A) photomicrograph showing ductal and myoepithelial in a mesenchymal background (H&E X10). Inset shows squamous metaplasia (H&E X40); B) positive mucicarmine staining indicating mucous metaplasia within the ductal cells, (mucicarmine X40)
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At areas keratin pearl formation was seen (Figure 2 A). Mucous metaplasia was also observed at many areas which was confirmed by positive mucicarmine staining (Figure 2 B).
A) gross examination of the tissue shows well encapsulated, ovoid mass of size approximately 2.5 x 2.5 x 3cm. Cut surface shows whitish solid area (inset) intermixed with yellow areas; B) Well encapsulated lesion showing thick fibrous capsule and myoepithelial cells in a chondromyxoid background (H&E X10); C) Abundant cystic-squamous lined structures filled with keratin (H&E X40); D) Double layered ductal structures characteristic of PA (H&E X40)
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Cut surface of the tissue showed whitish solid area with many places showing yellowish color (Figure 3 A). The histopathological examination of excisional tissue showed a covering of thick fibrous capsule (Figure 3 B) underneath which ductal epithelial cells was surrounded by myoepithelial cells in a chondromyxoid background. Mucin filled cystic spaces were seen at many places (Figure 3 B). Abundant cystic-squamous lined structures filled with keratin were observed indicating squamous differentiation with keratinization (Figure 3 C). Double layered ductal structures were also observed (Figure 3 D).