PMC9106233_01
An ulceroproliferative lesion over right lateral border of tongue with a polypoidal lesion at the upper end of the ulcer (arrow)
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F1
Clinical examination revealed a roughly 3 cm x 3 cm ulceroproliferative lesion with a tender polypoidal lesion approximately 2 cm x 1.5 cm in size, and the mobility of tongue was restricted in the form that the patient was unable to protrude the tongue out of mouth [Figure 1].
(a) Squamous cell carcinoma (SCC) with adjacent proliferative fasciitis (PF) (H&E, x40), (b) SCC, other areas, showing keratin pearl and invasion (H&E, x400), (c) PF showing fibroblastic and ganglionic (arrow and inset) spindle cells, and acute inflammatory infiltrate (H&E, x100)
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F2
Histologically, it showed a tumor composed of plump fibroblastic and myofibroblastic spindle cells with bland cytological features [Figure 2], collagenous to myxoid, predominantly collagenous stroma [Figure 3a and b].
Collagenous stroma in proliferative fasciitis ((a) H&E, x40, (b) H&E, x100). Nuclear features of ganglionic cells - Binucleation (c), large and lobulated (d) and mitosis (e) (H&E, x400)
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F3
Histologically, it showed a tumor composed of plump fibroblastic and myofibroblastic spindle cells with bland cytological features [Figure 2], collagenous to myxoid, predominantly collagenous stroma [Figure 3a and b]. These characteristic cells had abundant basophilic cytoplasm, one or two vesicular nuclei [Figure 3c] with single prominent nucleoli. Few large lobulated nuclei in these cells were also observed [Figure 3d]. Some mitoses (2-4 per 10 high-power fields) in both spindle and ganglionic cells [Figure 3e], plenty of acute inflammatory infiltrate and branching blood vessels were also present.
Immunohistochemistry - Calponin (a) and smooth muscle actin (SMA) (b) positivity in the fibroblastic spindle cells in proliferative fasciitis (PF) (H&E, x100). SMA positive ganglionic cells in PF ([c] H&E, x400). Pancytokeratin (d), Cytokeratin CK5/6 (e) and p63 (f) positivity in adjacent squamous cell carcinoma (H&E, x100)
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F4
Immunohistochemistry (IHC) showed immunopositivity for smooth muscle actin (SMA) and calponin [Figure 4].