PMC6360981_01
A Exophytic tumor on the lower lip. B -
Dermoscopy: structureless white yellowish zone (red arrow) and
polymorphous vessels (black arrows)
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f1
Physical examination showed a painful solid exophytic bleeding ulcerated pink tumor measuring 12x13mm, with telangiectasias and yellowish hue in the center involving the mucosa, semimucosa, and linea alba of the left third of the lower lip (Figure 1A). Dermoscopy showed a structureless heterogeneous yellowish and white central zone and an apple jelly hue in the lower lateral portion of the tumor with multiple polymorphous vessels in the periphery (dotted, coiled, and looped) (Figure 1B).
A Histology showing granular cell tumor and infiltration of
skeletal muscle on different magnifications (Hematoxylin & eosin,
x4, x10, and x40). B - Immunohistochemistry showing
negative S100 staining C - Tumor cells positive for CD56,
CD68 e vimentin
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f2
Histological examination revealed an exophytic ulcerated lesion consisting of cells with granular cytoplasm and homogeneous nuclei with low mitotic rate and no cellular atypia, located on the lamina propria and with skeletal muscle infiltration, without lymphatic involvement. (Figure 2A). On immunohistochemistry, the lesion was negative for S100, CD57, EMA, CD34, and neuron-specific enolase and positive for vimentin, CD68, and calretinin, weakly positive for CD56, with Ki67 proliferation index of approximately 3% (Figure 2B and 2C).
Surgical approach. A Presurgical demarcation with 5mm
margin. B - Fullthickness V-shaped excision. C
- Three-layer closure (oral mucosa, orbicularis oris muscle, and
skin)
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f3
A 3-layer closure (oral mucosa, orbicularis oris muscle, and overlying skin) was performed, and peripheral and deep margins were clear (Figure 3).