PMC5824524_01
Clinical photograph of the patient showing swelling of the left cheek
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F1
On extraoral examination, there was a diffused swelling on the left side of the face [Figure 1], which measured about 8 cm x 6 cm that extended superoinferiorly from temple region to 1 cm short of the base of the mandible and anteroposteriorly 1 cm short of ala of the nose to tragus of ear, which was mildly warm, tender and had variable consistency, i.e. firm to hard in center and soft to firm at the periphery.
(a) Ultrasonogram shows 4 cm hypoechoic foci. (b) Computed tomography shows soft-tissue mass with positive Holman-Miller sign in the lateral wall of the left maxillary sinus. (c) Magnetic resonance imaging shows isointense soft-tissue mass in T1-weighted images in the left masticator space
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F2
Ultrasonogram [Figure 2a] of the left cheek showed a hypoechoic focus of size 4 cm in intramuscular plane in masseter muscle extending up to the buccal space. Contrast-enhanced computed tomography (CT) [Figure 2b] showed a lobulated, 6 cm soft-tissue dense mass in the left masticator space, abutting lateral pterygoid and masseter muscles, with extension craniocaudally from the infratemporal fossa to the buccal space, anteriorly to the lateral wall of orbit and zygomaticus major, medially to the pterygomaxillary fissure and para maxillary space; posteriorly, it is confined within the masseter muscle.
(a) Preoperative patient preparation. (b) Extraoral incision and exposure of the mass. (c) Soft-tissue mass after excision. (d) Cut section of the excised mass. (e) Postoperative profile after 2 months
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F3
After obtaining the consent, photographs were taken and diagnostic and therapeutic excision was executed on July 2015 under general anesthesia through extraoral approach, and the mass was removed in toto by applying countertraction [Figure 3a-e].
(a and b) Histopathological picture showing fibrous tissues along with scattered vascular channels x50 and x100, respectively
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F4
There is no increase in mitotic figures or evidence of atypia [Figure 4a and b], and the features were compatible with the pathohistological diagnosis of angiofibroma.
(a) Immunohistochemical stain of angiofibroma showing vimentin-positive fibroblastic stroma x100. (b) Immunohistochemical stain of angiofibroma showing CD 34 shows positive for vascular channels x100
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F5