PMC9106240_01
(a) Clinical photograph showing swelling in the posterior right-side lingual vestibule. (b) Photograph of gross incisional tissue
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F1
Intra-oral examination showed the presence of swelling in the right mandibular region [Figure 1a]. Incisional biopsy [Figure 1b] was performed and tissue was sent for histopathological examination.
(a) Panoramic radiograph of patient showing a lytic lesion. (b) Computed tomography scan of the patient showing a lytic lesion with resorption of buccal and lingual cortical plates of the right-side posterior mandible
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F2
Radiographic images revealed an osteolytic lesion in the mandibular right 44 to 47 region, which was round to oval and uncorticated along with thinning of the lower border on the same side with intervening radiopaque septae in the radiolucency [Figure 2a]. The tumor caused expansion and perforation of both buccal and lingual cortical plates resulting in bulging of the tumor mass [Figure 2b].
(a) Photomicrograph showing numerous round to oval follicles lined by a single layer of cuboidal to low columnar epithelial cells, containing eosinophilic colloid like material in the lumen (H&E stain, x400) (b) photomicrograph showing colloid material to be weakly Pas positive (Per iodic Acid Schiff stain, x400)
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F3
The lumen of follicles contained eosinophilic colloid-like material [Figure 3a]. Follicles and colloid-like material also showed positivity with periodic acid Shiff (PAS) staining [Figure 3b].
(a) Tumor cells forming macrofollicular and microfollicular pattern (H and E stain, x100) (b) (H&E stain, x400)
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F4
Tumor cells in areas formed macrofollicular patterns along with microfollicles [Figure 4a and b].
(a) Photomicrograph showing the trabecular and solid pattern of follicles with tumor cells exhibiting pleomorphism and hyperchromasia (H&E stain, 100x) (b) (H&E stain, x400)
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F5
The trabecular and solid patterns of follicles were also present in few areas with tumor cells exhibiting mild pleomorphism and hyperchromatism [Figure 5a and b].
(a) Photomicrograph showing stromal hyalinization (H&E stain, x100) (b) (H&E stain, x400)
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F6
Stromal hyalinization was also seen [Figure 6a and b].
Immunopositivity for thyroglobulin, thyroid transcription factor-1 and Pax 8 and tumor cells are immunonegative for S100 and calretinin (x400)
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F7
Tg, thyroid transcription factor-1 (TTF-1) and paired box gene 8 (Pax8) and immunonegative for S100 protein and Calretinin [Figure 7]. The patient was referred to an oncologist for further management.