PMC5406795_01
Extraoral picture revealing facial asymmetry on the left side
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F1
Extraoral examination revealed facial asymmetry on the left side with diffuse swelling measuring approximately 7 cm x 5 cm extending anteroposteriorly 4 cm away from the angle of the mouth to the posterior border of the mandible and superoinferiorly from tragus of the ear to lower border of the mandible [Figure 1].
Intraoral picture revealing restricted mouth opening
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F2
Intraoral examination revealed swelling in the left mandibular vestibule extending anteroposteriorly from mesial aspect of 37 to anterior border of the ramus of the mandible [Figure 2].
(a and b) Orthopantomograph and computed tomography scan revealing radiolucency at the left ramus region
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F3
On radiographic examination, orthopantomograph (OPG) revealed irregular radiolucency extending anteroposteriorly from distal aspect of 38 to posterior border of ramus of the mandible and superoinferiorly from sigmoid notch to lower border of the mandible [Figure 3a]. Three-dimensional computed tomography scan revealed perforation at left ramus region with extensions as that of OPG [Figure 3b].
Excision of the tumor
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F4
As there was restricted mouth opening, complete surgical excision of the lesion was performed [Figure 4] and sent for histopathological examination.
Histopathology revealing fascicles of elongated spindle cells admixed with dense lymphocytes (a) spindle cells are plump ovoid to tapering hyperchromatic nuclei with mild nuclear atypia (b)
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F5
Histopathology revealed nonencapsulated mass with fascicles of elongated spindle cells in fibrous stroma admixed with intense chronic inflammatory cell infiltrate, predominantly of lymphocytes [Figure 5a]. The spindle cells exhibited plump ovoid to tapering hyperchromatic nuclei with indistinct cell boundaries and mild nuclear atypia [Figure 5b].
Immunohistochemistry revealing positivity for vimentin (a), smooth muscle actin (b), anaplastic lymphoma kinase (c) and negativity for s-100 (d)
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F6
S-100. Spindle cells positivity was noticed with vimentin [Figure 6a], alpha-SMA [Figure 6b] and ALK [Figure 6c] and negativity with respect to S-100 [Figure 6d].