PMC8105109_01
Ultrasonography shows a well-defined hypoechoic heterogenous mass lying between the skin and buccinator muscle.
CRID2021-9940304.001.jpg
PMC8105109_01_CRID2021-9940304.001.jpg
fig1
The results of ultrasonography indicated a well-defined hypoechoic heterogeneous mass lying beneath the skin measuring 13*18 mm (Figure 1).
Coronal MDCT image shows a circular well-defined homogenous mass in the right buccal area.
CRID2021-9940304.002.jpg
PMC8105109_01_CRID2021-9940304.002.jpg
fig2
MDCT showed a circular well-defined homogenous mass over the buccinator muscle (Figure 2).
(a) Axial T1 MRI shows a low signal homogenous mass in the right lying over the buccinator muscle and under the skin. (b) Axial T2 MRI shows the lesion as high signal and homogenous.
CRID2021-9940304.003.jpg
PMC8105109_01_CRID2021-9940304.003.jpg
fig3
T1 sequence showed a well-defined low signal mass between the buccinator muscle and buccal fat (Figure 3(a)). The MRI T2 sequence showed that the mass is homogenous and high signal (Figure 3(b)).
Intraoral incision on the buccal mucosa revealed a spherical lesion just underneath the buccinator muscle.
CRID2021-9940304.004.jpg
PMC8105109_01_CRID2021-9940304.004.jpg
fig4
Upon obtaining consent, an excisional biopsy was performed under local anesthesia and incision was made on the buccal mucosa just over the palpated mass (Figure 4).
Image shows gross specimen, a spherical brown-gray firm tissue, measuring 1 cm in diameter.
CRID2021-9940304.005.jpg
PMC8105109_01_CRID2021-9940304.005.jpg
fig5
The lesion was completely excised (Figure 5).
(a) Thin blood vessels with papillary projections in the fibrous stroma (x40). (b) Paralleling pattern of fascicle and glomus cells around the blood vessels (x100).
CRID2021-9940304.006.jpg
PMC8105109_01_CRID2021-9940304.006.jpg
fig6
The thin-wall blood vessels showed papillary projections to the lumen which some had become irregular, large in size, and even sinusoid in some areas (Figure 6(a)). The stroma contains immature spindle-shaped fibroblasts with a paralleling fascicle pattern next to the blood vessels (Figure 6(b)).
(a) x40 and (b) x100 positive IHC staining for SMA. (c) x40 and (d) x100 positive for desmin.
CRID2021-9940304.007.jpg
PMC8105109_01_CRID2021-9940304.007.jpg
fig7
In the IHC staining analysis, the specimen was positive for both SMA (smooth muscle actin) (Figures 7(a) and 7(b)) and desmin (Figures 7(c) and 7(d)); however, the microscopic features in combination with IHC findings were consistent with angioleiomyoma diagnosis.