PMC4795141_01
Preoperative view of the lesion
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F1
On intra-oral examination, a desquamated gingival lesion [Figure 1] was seen on the marginal and attached gingiva extending from the distal aspect of 35 to mesial aspect of 37 measuring approximately about 3.5 cm x 1 cm in size and was bright red in color with slightly elevated margins and bleeding on slight provocation.
Intraoral periapical radiograph
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F2
The preoperative intraoral periapical radiograph and orthopantogram [Figures 2 and 3] revealed horizontal bone loss mesial to 35 regions, but there was no aggressive bony destruction around this area.
Preoperative orthopantogram
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F3
The preoperative intraoral periapical radiograph and orthopantogram [Figures 2 and 3] revealed horizontal bone loss mesial to 35 regions, but there was no aggressive bony destruction around this area.
H and E, x4 showing Islands of malignant squamous epithelial cells invading into connective tissue stroma
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F4
Sections from the biopsied specimens stained with hematoxylin and eosin [Figures 4 and 5] revealed neoplastic squamous epithelial cells invading the connective tissue stroma arranged in form of Islands and sheets exhibiting increased nuclear-cytoplasmic ratio, cellular pleomorphism, nuclear hyperchromatism, individual cell keratinization, abnormal and atypical mitotic figures, and keratin pearl formation.
H and E, x40 demonstrating individual neoplastic squamous epithelial Islands with keratin pearl formation
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F5
Sections from the biopsied specimens stained with hematoxylin and eosin [Figures 4 and 5] revealed neoplastic squamous epithelial cells invading the connective tissue stroma arranged in form of Islands and sheets exhibiting increased nuclear-cytoplasmic ratio, cellular pleomorphism, nuclear hyperchromatism, individual cell keratinization, abnormal and atypical mitotic figures, and keratin pearl formation.
Chest radiograph with no evidence of secondary malignancy
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F6
To rule out metastasis in the lung, chest X-ray was advised and was found to be clear [Figure 6].
Postoperative view Figure
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F7
The patient underwent surgical extraction from 41 to 38 with peripheral osteotomy leaving 2-3 cm of the inferior border of the mandible [Figure 7].
Postoperative orthopantogram
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F8
Hemostasis was done and primary closure was achieved [Figure 8].