A 78-year-old male complained of postextraction pain in right lower jaw; 46, 47, 48 had been extracted 4 days as they were mobile and painful for the past 6 months. Extra orally, there was a 3 × 4 cm sized firm, nontender swelling in the right submandibular region. A single submandibular node was palpable and fixed. Intra orally, there was a tender ulcer in the floor of the mouth in the right lingual vestibule with central yellow slough.
HISTOPATHOLOGY
Ulcerated nonkeratinising surface epithelium in association with an inflamed fibrovascular connective tissue exhibiting infiltrating islands and nests of neoplastic epithelial cells [Figure 1 surface epithelium not seen in the picture].
Figure 1
Infiltrating Islands and nests of neoplastic epithelial cells in a fibrous connective tissue (Original magnification, 4×)
Infiltrating Islands and nests of neoplastic epithelial cells in a fibrous connective tissue (Original magnification, 4×)Variably sized duct like structures and microcystic areas were seen within the islands and nests [Figures 1 and 2].
Figure 2
Duct like structures and microcystic areas lined by two layers of cells (Original magnification, 10×)
Duct like structures and microcystic areas lined by two layers of cells (Original magnification, 10×)Duct like structures were lined with two layers of cells; luminal cuboidal cells and abluminal (basal) of layer of clear cells [Figures 2–4].
Figure 4
A nother area Showing luminal cuboidal cells and abluminal clear cells and dense hyalinised basement membrane (Original magnification, 40×)
Higher magnification showing luminal intercalated Duct like cells and abluminal clear cells. (Original magnification, 40×)A nother area Showing luminal cuboidal cells and abluminal clear cells and dense hyalinised basement membrane (Original magnification, 40×)The inner layer of cuboidal cells were similar to epithelium of normal intercalated ducts, with eosinophilic cytoplasm and nucleus exhibiting fine chromatin. This was surrounded by an abluminal (basa) l layer of larger cells with clear cytoplasm and basophilic round to oval nuclei [Figures 2–4].Dense hyalinized basement membrane of variable thickness surrounding the islands of neoplastic epithelial cells [Figure 4].
Basal cells were positive for both S-100 and p63. However, p63 staining was more uniform and confined to the basal layer. [Figures 5 and 6; S-100, p63, respectively] confirming basal cells as myoepithelial cells.
Figure 5
S – 100 immunohistochemistry
Figure 6
p63 immunohistochemistry
S – 100 immunohistochemistryp63 immunohistochemistry
Figure 1
Figure 2
Figure 4
Figure 5
Figure 6