PMC6463331_01
(A) Extra oral photograph shows swelling on the left side of the face causing nasal deviation; (B) intra-oral photograph shows swelling involving the left maxilla, crossing the midline and obliterating the labial vestibule; and (C) CECT shows heterogeneously enhancing mass involving the left maxilla. CECT indicates contrast-enhanced computed tomography.
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On extraoral examination, diffuse swelling was present on the left side of the face extending from midline to 4 cm posteriorly toward the outer canthus of eye and from corner of mouth to 4.5 cm superiorly toward the inferior orbital margin and was causing deviation of the nasal septum to the right side (Figure 1A). Grade I mobility was observed in these teeth (Figure 1B). It was indenting over the left inferior turbinate and extending into the left anterior nasal cavity (Figure 1C).
(A) Microphotograph shows spindle-shaped cells arranged in whorls and storiform pattern (10x) (inset 4x); (B) microphotograph shows abnormal mitosis (arrow) in tumor cells (40x); (C) microphotograph shows foci of osteoid formation (10x); and (D) microphotograph shows tumor osteoid lined by atypical osteoblasts (40x).
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Cells in cross section showed vesicular nuclei with vacuolar degeneration of the cytoplasm (Figure 2A). Two to four abnormal mitotic figures were observed per 10 high power fields (Figure 2B). Malignant osteoid formation was seen only at foci (Figure 2C and D).
Microphotographs showing immunopositivity for Cytokeratin AE1/3 and vimentin (A and B, respectively) and immunonegativity for Desmin, SMA, S100, CD99, bcl-2, and EMA (C to H, respectively) (inset: controls). CK indicates cytokeratin; EMA, epithelial membrane antigen; SMA, smooth muscle actin.
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Tumor cells were diffusely positive for pan-cytokeratin (AE1/3) and vimentin and negative for S100, smooth muscle actin (SMA), Desmin, bcl-2, and CD99 (Figure 3A to G). The tumor cells were positive for vimentin and pan-cytokeratin and negative for EMA (Figure 3A, B, and H).