PMC4065425_01
Soft tissue gingival mass in lower left posterior region occupying vestibular space as well as lingual sulcus
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F1
The lesion occupied the whole left buccal vestibular space leading to extraoral left side midfacial enlargement [Figure 1].
Orthopantomogram reveals no underlying bony origin and displacement of premolar and molars along with bony resorption on left mandibular jaw
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F2
Panoramic radiograph revealed only erosion of underlying bone and no definite osseous component along with displacement of associated premolars and molars [Figure 2].
Excised gross specimen along with extracted teeth.
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F3
Grossly, a soft tissue nodular mass of approximately 3 x 3 cm, firm in consistency with grayish-white appearance and two associated mandibular premolars were submitted [Figure 3].
PMC4065425_02
(a) Surface epithelium with underlying connective tissue showing variably sized vessels in eosinophilic spindle cell stromal population (H&E stain, x40). (b) Large thick-walled vessels associated with intersecting fascicles of spindle shaped smooth muscle cells (H&E stain, x100). (c) Thick vessel wall composed of smooth muscle cells mingling with intervascular stroma (H&E stain, x100). (d) Spindle smooth muscle cells with eosinophilic cytoplasm and cigar-shaped bluntended nuclei with perinuclear vacuole (H&E stain, x400)
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F4
Many vessels showed thin-dilated wall and myxoid inter-vascular stroma [Figure 4a-d].
IHC for SMA shows diffuse positivity in tumor stroma (IHC stain, x100)
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F5
A diagnosis of angioleiomyoma was given and immunohistochemistry (IHC) for smooth muscle actin (SMA) showed diffuse intense positivity in vascular wall and intervascular stroma confirming their smooth muscle nature [Figures 5 and 6].
Intense cytoplasmic SMA staining of tumor smooth muscle cells (IHC stain, x400)
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F6
A diagnosis of angioleiomyoma was given and immunohistochemistry (IHC) for smooth muscle actin (SMA) showed diffuse intense positivity in vascular wall and intervascular stroma confirming their smooth muscle nature [Figures 5 and 6].