PMC3961943_01
(a) Diffuse extra-oral swelling on the right side of the face, (b) Intra-oral mass with surface ulceration involving the right buccal mucosa and the posteriolateral aspect of the hard palate (c) Axial CT view depicting an expansile soft tissue lesion in the right bucco-gingival space with slight erosion of maxilla (d) Extra-oral swelling (10 days following incisional biopsy) (e) Enlargement of intra-oral mass involving entire right buccal mucosa and hard palate (f) Partial improvement noticed during the treatment's initial phase
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F1
The skin overlying the swelling appeared shiny and stretched with ulceration [Figure 1a]. The mass extended anteriorly from the right mandibular first premolar region to the retromolar region posteriorly with involvement of the posterior-lateral aspect of hard palate [Figure 1b]. Computerized tomography revealed a large expansile lesion with respect to right gingivo-buccal space showing slight erosion of the maxilla [Figure 1c]. Within a period of 10 days after the incisional biopsy, there was considerable increase in the size of extra-oral swelling along with an enormous increase in the intra-oral soft tissue mass involving the entire right buccal mucosa and hard palate [Figure 1d and e]. Partial recovery occurred during the treatment's initial phase [Figure 1f] but with tapering of chemotherapeutic doses, there was sudden flare up in the tumor size.
(a) Photomicrograph of the histopathologic section reveals sheets of atypical round cells having abundant eosinophilic cytoplasm with few areas showing vacuolated cells (H and E, x200) (b) Photomicrograph demonstrates atypical rhabdomyoblasts with nuclear pleomorphism and few vacuolated cells (H and E, x400)
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F2
An incisional biopsy of the mass was performed and the histopathology of the specimen disclosed embryonal rhabdomyosarcoma [Figure 2a and b].