PMC4860915_01
(a) Extra-oral firm swelling over left mandible and submandibular region with diffuse borders. (b) Intraoral swelling obliterating buccal vestibule from 33 to 36 region
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F1
Extraorally, a firm swelling of 5 cm x 4 cm with diffuse borders involved the left body of mandible extending in the submandibular region [Figure 1a]. Intraorally, the swelling obliterated the left buccal vestibule from distal of canine to distal aspect of the first molar with Grade I mobility of associated teeth [Figure 1b].
(a) Orthopantomography showing mixed radiolucentradiopaque lesion from distal of 33 to distal of 36, intact inferior border and periosteal reaction along the lower border of mandible (Sun-burst appearance). (b) Radiograph showing periosteal reaction along the lower border of mandible (Sun-burst appearance). (c) Axial computed tomography showing soft tissue density mass surrounding left mandible with erosion of underlying bone. (d) Reduction in size of lesion involving left mandibular body after chemotherapy and radiotherapy
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F2
Radiographically, orthopantomography and lateral cephalogram showed mixed radiolucent-radiopaque lesion in premolar-molar region of left mandible with periosteal reaction along the lower border of mandible giving sunburst appearance [Figure 2a and b]. The lesion caused cortical erosion and destruction of mandibular body along with irregular periosteal reaction [Figure 2c]. Considerable reduction in the size of the lesion was evident after chemotherapy and radiotherapy [Figure 2d].
(a) Fine needle aspiration cytology of the lesion showing small round blue cells with scant cytoplasm, hyperchromatic and pleomorphic nuclei (H&E stain, x400) (b) Parakeratinized stratified squamous epithelium overlying deeper connective tissue with dense infiltration of small round blue cells (H&E stain, x100). (c) Round cells with pleomorphic and hyperchromatic nuclei and scant cytoplasm interspersed with small mature lymphocytes in the background of moderate to dense vascularity (H&E stain, x200)
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F3
Fine needle aspiration cytology of the lesion showed small round blue cells with scant cytoplasm, hyperchromatic and pleomorphic nuclei with dispersed chromatin which suggested a round blue cell neoplasm [Figure 3a]. This indicated a small round blue cell neoplasm [Figure 3b and c].
Photomicrographs of immunohistochemical markers that were negative: (a) EMA (IHC stain, x40), (b) myogenin (IHC stain, x400), (c)pancytokeratin (IHC stain, x100), (d) leukocyte common antigen (CD45) (IHC stain, x400), (e) CD2 (IHC stain, x400), (f) CD3 (IHC stain, x400), (g) CD5 (IHC stain, x200), (h) CD7. (IHCstain, x200)
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F4
Photomicrographs of immunohistochemical markers that were positive: (a) Terminal deoxynucleotidyl transferase (IHC stain, x100), (b) CD99 (IHC stain, x200), (c) PAX5 (IHC stain, x400), (d) CD10 (IHC stain, x100), (e) CD20 (IHC stain, x100), (f) Diagnostic flow-chart of pre-B-cell lymphoblastic lymphoma
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F5