PMC6079601_01
(a) Clinical and (b) intraoral picture showing an intact buccal mucosa. (c) Water's view radiograph of the patient. (d) Gross incisional tissue.
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fig1
The swelling was firm in consistency, nontender, and of approximately 5 x 4 cm, extending superoinferiorly from the infraorbital ridge to 2 cm above the inferior border of the mandible and anteroposteriorly from the right corner of the mouth to 1.5 cm anterior to the tragus (Figure 1(a)). Intraoral examination revealed no obvious swelling with intact oral mucosa, and scattered foci of Fordyce's spots were seen on the buccal mucosa (Figure 1(b)). Water's view of the skull showed impression of the soft tissue swelling in the right cheek area (Figure 1(c)). A definite clinical diagnosis was not possible, and an incisional biopsy (Figure 1(d)) was taken from the buccal mucosa and subjected to histopathological examination.
PMC6079601_02
Pattern of asymmetry, a lack of circumscription with pushing or locally infiltrating margins (H and E stain; original magnification, 4x).
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fig2
Microscopically, the tumor mass appeared to be located in the deeper mucosa with pushing margins of tumor nests (Figure 2).
Large nests or lobules of neoplastic cells with squamous appearance, separated by scant stroma (H and E stain; original magnification, 10x).
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fig3
The tumor was composed of large nests of neoplastic cells with squamous appearance, separated by scanty stroma (Figure 3).
Neoplastic cells had large vesicular nuclei with prominent nucleoli. Cellular and nuclear pleomorphism with few nuclei showing multilobation. Scattered typical and atypical mitotic figures seen (H and E stain; original magnification, 20x).
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fig4
Cellular and nuclear pleomorphism with few nuclei showing multilobation was seen, along with typical and atypical mitotic figures (Figures 4 and 5).
Sheets of multivacuolated/vesiculated cells having squamoid appearance, multilobation of some nuclei, high mitotic rate with abnormal mitosis (H and E stain; original magnification, 100x).
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fig5
Cellular and nuclear pleomorphism with few nuclei showing multilobation was seen, along with typical and atypical mitotic figures (Figures 4 and 5).
Photomicrograph showing lobules composed of clear tumor cells with foamy cytoplasm exhibiting absence of any mucin on PAS stain. (a) H and E stain; original magnification, 10x. (b) PAS stain; original magnification, 40x.
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fig6
The sebaceous nests were composed of clear tumor cells with foamy cytoplasm exhibiting absence of mucin on periodic acid-Schiff (PAS) stain (Figure 6).
Variable number of smaller, darkly staining basaloid cells with oval-shaped nuclei and scant cytoplasm (H and E stain; original magnification, 40X).
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fig7
In contrast, a variable number of smaller, darkly staining basaloid cells with oval-shaped nuclei and scant cytoplasm were also seen (Figure 7).