PMC4357080_01
PMC4357080_02
a) panoramic radiograph revealed irregular ragged borders on the right side of mandible, b) extra oral swelling on the right side of mandible, c) extra oral swelling involving submental region on right side, d) intra orally a diffuse swelling seen on the right side of the alveolus
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F1
On palpation, there was buccal cortical plate expansion that was nontender and firm. [Figure 1] Based on the history, past history and clinical examination, recurrent fibrosarcoma was given on the right side.
a) Panoramic radiograph revealing floating teeth appearance of 43.44 and 45, b) post operative panoramic radiograph revealing irregular, ragged borders on the lower right side of mandible, c) CT scan revealing soft tissue density mass on the right side of mandible, d) CBCT revealed few bone islands with complete destruction of both buccal and lingual cortical plates
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F2
Few subcentimeter lymph nodes on the right side at level two were seen, with the largest measuring 6 mm x 7 mm [Figure 2].
PMC4357080_03
a) photomicrograph of H and E section showing spindle cells, b) NSE immunohistochemistry was positive, c) S-100 stain, d) vimentin stain
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F3
The tissue was strongly reactive for vimentin, [Figure 3] S-100 and nuclear specific enolase [Figure 3] and negative for cytokeratin and CD 34; hence, favoring the diagnosis for MPNST.
Post operative clinical photograph after hemimandibulectomy and radiation therapy with post operative panoramic radiograph
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F4
Excision of the lesion was performed where hemimandibulectomy was performed and the specimen was sent for IHC investigation [Figure 4].