PMC10207186_01
(a) Extraoral photograph showing diffuse swelling in the buccal, nasogenian, and submandibular region on the right side. (b) Intraoral photograph showing a tumour-like lesion located in the middle and posterior third of the edentulous alveolar ridge and involving the buccal and lingual regions of the right side of the mandible
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F1
Submandibular lymph node group IB and upper jugular lymph node group IIB, both on the right side, were positive [Figure 1a]. Intraoral examination revealed a tumour-like lesion located in the middle and posterior third of the edentulous alveolar ridge and involving the buccal and lingual region of the right side of the mandible, which extended to the retromolar area of the same side, irregular shape and surface, erythematous colour with yellowish areas, diffuse borders, and soft consistency [Figure 1b].
An orthopantomography showing a radiolucent lesion with poorly defined borders located in the body and ramus of the mandible on the right side
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F2
Incisional biopsy was performed and analysed by the oral and maxillofacial pathology service [Figure 2].
(a) Haematoxylin and eosin (H&E) histopathological examination (4x) showing a neoplasm formed by sheets, nests, follicles, and trabeculae spanning the epithelium. (b) H&E histopathological examination (40x) showing follicles with a central area of comedonecrosis and some star-shaped cells. Peripheral cells have hyperchromatic nuclei with focal reverse polarity. (c and d) H&E histopathological examination (40x) showed the presence of cellular pleomorphism, increased nuclear-cytoplasm ratio, nuclear hyperchromatism, and abnormal mitosis. In the dense fibrous connective tissue stroma, some areas close to the neoplastic cells exhibited hypercellularity and spindle cells formed a streaming pattern
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F3
The rest of the stroma was loose, dense fibrous connective tissue with diffuse severe chronic inflammatory infiltrate, covered by stratified squamous parakeratinised epithelium with areas of acanthosis, cellular and nuclear pleomorphism, and pyknotic nuclei [Figure 3a-d].
Immunohistochemistry: (a) showing moderately positive staining for Ki-67 (Ki-67, 40x); (b) showing highly positive staining for SOX2 (SOX2, 40x)
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F4