Section I: Consists of cases from 1-7.

Section II: Consists of cases from 8 -13.

Section III: Consists of cases from 14 -21.

Section IV: Consists of cases from 22 - 28
Section V:
Case 29:  Case 30:  Case 31:  Case 32:  Case 33:  Case 34:  Case 35:  Case 36:  Case 37:  Case 38:

Case 29: 12 yrs old male patient came with a soft tissue swelling, periapical radiograph revealed an impacted lower left canine (43) and a radiolucent lesion measuring 1.5 cm. in diameter surrounding the impacted canine. The provisional diagnosis of dentigerous cyst was made. The impacted tooth was moderately hypoplastic but resembles a canine.

Click here for photmicrographs

Members Interpretations of the case:

Charles E. Tomich
Based upon the photomics, I think this is a central odontogenic firbroma, WHO type

Nirmala N Rao
The H/P is in favour of localized regional odonto dysplasia,there is evidence of follicular tissue with focal collections of calcifications and islands of odotogenic epithilium of varied sizes.Confirm this by subjecting the tooth for ground sectioning.

Charu miglani
Calcifying epithelial odontogenic tumor

Elias  Romero
Gorlin's  Cyst

Keya Sircar
Adenomatoid Odontogenic tumour

Ashish Bodhade
Odontogenic lesional tissue appears to be mixed epthelial- mesenchymal interaction with calcification. Ameloblastic fibroodontoma. or Odontogenic fibroma WHO type

Manish
The photomicrographs show highly cellular areas forming a whorled pattern, areas of calcification which resemble liesegang ring calcification, an odontogenic epithelial island forming a follicle with tall columnar cells, a cluster of clear cells is also seen and areas of amorphous eosinophlic substance can be seen. Keeping these things in mind the diagnosis of AOT with areas of CEOT can be given. The history also favors this diagnosis. More sections/photomicrographs are advisable to further confirm.

Susmita Saxena
Adenomatoid Odontogenic Tumour

Fantasia
c/w regional odontodysplasia

C.D. Mario Nava
Adenomatoid odontogenic tumor

Maria Auxiliadora
Adenomatoid odontogenic tumor

James Cade
Odontogenic changes seen with a developing odontoma

Carl Allen
I would be interested to see the radiograph, but the photomicrographs are at least suggestive of regional odontodysplasia.

Yeshwant Rawal
Regional Odontodysplasia.
                                                                                                                                                                     ▲Top

Case 30:  A slow growing soft tissue swelling in the midpalatine region at the junction of hard and soft palate of seven year duration. Swelling measuring around 1.5x2cms, soft in consistency and non tender on palpation.
        An encapsulated tumor characterized by peripheral lipomatous tissue and central salivary gland elements with prominent dilation of ducts was seen. Intraoral lipoma is a well-known entity but lipomatous tumors including salivary gland tissue are uncommon. Is it a case of sialolipoma ??

Click here for photomicrographs

Members Interpretations of the case

Charles E. Tomich
Based upon the photomics, I would call this a lipoma but sialolipoma does sound good too

Ponniah
The diagnosis of  intra glandular lipoma in the context of minor salivary gland is difficult to establish. This difficulty largely stem from the fact that there are no distinct boundaries in this region unlike the case in the major salivary gland, especially parotid gland lipoma. However, the presence of effaced acinar units and cicumscription of the lesion indicate primary involvement of minor salivary gland by the lipomatous proliferation but the salivary duct dilatation as seen in the photomicrgraphs would favour secondary involvement. In general this type of lesion go unreported making any assessment of criteria for minor salivary gland lipoma difficult. The presence of residual salivary gland units in amid lipomatous proliferation is a rare event in oral biopsies.

K.Karunakaran
Lipoma in minor salivary gland.

Elias  Romero
Hamartoma

Mostafa
The diagnosis of case 30 in my opinion is :
Salivary mucocele

Manish
The photomicrographs show a prominent adipose tissue component and a few mucous acini with dilated ducts. No encapsulation is seen in the photomicrographs. Sialolipoma is a rare tumor; the diagnosis of sialolipoma is given when salivary gland component is also a part of the neoplastic process. Salivary gland tissue is normally found in the palatal region. To confirm the diagnosis as sialolipoma it will be necessary to figure out if salivary component is a part of the neoplastic process or a mere entrapment by the lipomatous growth on the palate. Extensive sectioning should also be done to rule out any salivary gland neoplasm. If we can rule out that salivary gland tissue is a part of the tumor then it is better to call it as Lipoma rather than sialolipoma.

Atilio Silva
Hamartoma

B V Ramana Reddy
Lipoma

Susmita Saxena
Lipoma
Glandular element is non-neoplastic and is normal in that location

K.Kiran Kumar
The histopathological features are suggestive of SAILOLIPOMA. There is a statified squamous epithelium with well capsulated. Underlying connective tissue exhibits both adipocytes and glandular epithelium and some sections shows ductal pattern. All these features are suugestive of Sailolipoma. NOTE- location - hard palate. Sailolipoma most commonly appears between hard and soft palate

Fantasia
Gross And Histology Suggestive Of A Lipomatous Process, Photomicrographs Of Poor Quality Thus Comments Of Limiited Value

Decio S. Pinto Jr
It may be a low-grade liposarcoma.  

C.D. Mario Nava
I believe that it is a lipoma with salivary gland elements traped, nonetheless, the description of sialolipoma is consistent with the very few cases reported.

Axel-Ruprecht@Uiowa
I am not a pathologist, rather a radiologist. My interpretation of the CT was lipoma. I should be interested to hear what the pathologists have to say.

CSBR.Prasad
Hamartoma.

Tore Solheim
Pictures are not too clear, but it is most similar to a mucoepidermoid carcinoma. the epidermoid part is not obvious.

T. Mahesh Babu
D/D: Polymorphous Low Grade Carcinoma, Mucoeidermoid Carcinoma(Intermediate Grade). 

James Cade
Necrotizing sialometaplasia with palatal fatty tissue

Adi Rahmadsyah
It seems to be a  mixed tumor involving salivary gland,which of course the present of adipose tissue is a rare. Few results of high power view are little bit fuzzy.

Theodore Zislis
Lipoma with entrapped non-neoplastic salivary gland

Susan Zunt
I think that this may be an example of the so-called sialolipoma. 

Carl Allen
I think this is simply a lipoma that developed in an area that happened to have some salivary gland tissue.  The lipoma (similar to neurofibroma) often intermingles with adjacent normal tissue.  Certainly some are encapsulated, but others are not. 

Prof.Paolo Boccato
Possible Polymorphous Adenocarcinoma Of Low Grade
                                                                                                                                                                      ▲Top

Case 31:  This is a case of swelling in the floor of the mouth in a 45 year old female of 3 years duration. Examination showed mass in the floor of the mouth without ulceration or bleeding from the lesion. Tonguemovement was not restricted. There was no lymphadenopathy of the regional nodes. Computed Tomography scan report was that of chronic sialadenitis. Thorough clinical examinations of other organs system fail to disclose any pathological lesion.
        Incisional biopsy was performed and studied routinely. The sublingual gland was removed and submitted for post-operative evaluation. Cut surface showed microcystic areas, necrosis and hemorrhage. The photomicrographs were taken from the most representative areas of the section examined.

Click here for photomicrographs

Members Interpretations of the case
Nirmala N Rao

Suggestive Of Adenoid Cystic Carcinoma-Cribriform Type.D/D Can Be Plga,To Confirm Employ Ema And Cea These Antigen Stain The Luminal Cells Of Acc This May Help To Differentiate Acc From Plga.Also The H/P Shows  Abundent Cribriform Areas Which Are Not Typical For Plga.

Santosh Hunasgi

Featutres are comedo necrosis, lymphatic infiltration, fatty degeneration, lymphatic spaces, hyperchromatic cells. Suggestive of sialadenitis with comedo necrosis ??

Sachin Sarode

Features are suggestive of  

Adenoid cystic carcinoma

Mehraj Shams

Adenoid Cystic Carcinoma

Kraisorn Sappayatosok/ Kittipong Dhanuthai

Adenoid cystic carcinoma

Keya Sircar

Necrotizing sialometaplasia

CSBR.Prasad

PLGA

Farzan Naveen

Few sections seems like Clear cell variant of epithelial-myoepithelial carcinoma. Or Hybrid carcinoma- adenoid cystic

Carcinoma & epithelialmyoepithelial carcinoma

Special immunostains can be used such as AE1:AE3 

S-100 protein 

Vimentin to come to conclusion

Anila Pc

ACC with chronic sialedenitis. Diagnosis ably supported by our Gen Path Dr.Swarna

Marco Torres

Adenoid cystic carcinoma

Elias  Romero

Adenoid  cystic  carcinoma

Indraneel Bhattacharyya

Some of the photos appear to be adenoid cystic carcinoma -like. One or two of the pictures are suggestive of follicular ca of thyroid.

Mario Nava

Epithelial-Myoepithelial Carcinoma (Vs Adenocarcinoma Nos)

Charles E. Tomich

Adenocarcinoma, possibly and adenoid cystic carcinoma

Darunee Jintakanon

Polymorphous Low Grade Adenocarcinoma Vs Adenoid Cystic Carcinoma

Mary Toner

Probably Acinic Cell Carcinoma

James Cade

Adenoid cystic carcinoma, rule out metastatic adeno carcinoma

Siva

Look like Ductal Carcinoma

Harry Lumerman

Adenoid Cystic Carcinoma

Fábio Pires

Adenoid cystic carcinoma

Yeshwant Rawal

Adenoid Cystic Carcinoma

Gerardo

Adenoid Cystic Carninoma Grade 2                                               ▲Top

Case 32:  Enucleated specimen from a 18 year old patient was submitted for microscopic examination. Further communication with the attendant surgeon revealed that the patient suffered from a painful swelling in the left lower jaw (35 to retro molar region), aspiration was positive.
Click here for photomicrographs
Author's view: We thank the chief moderator for posting the members interpretation and the members for their valuable time and effort in the interpretations of the case 32.
We agree with Dr. N.Chaitanya Babu that the case description was inadequate. But were disappointed over the members interpretations. Most have called it GOC while others have deemed it as OKC or CYSTIC AMELOBLASTOMA.
    The case 32, according to our interpretation is a possible cystic variant of AMELOBLASTIC FIBROMA with ghost cells and dentinoid formation. If one goes by the presence of ghost cells and dentinoid [photomicrograph 1 in the first row and 3 in the second row] it can be interpreted as CALCIFYING ODONTOGENIC CYST. On the other hand, the presence of cyst - like or duct - like areas within the lining epithelium would strongly suggest the possibility of GLANDULAR ODONTOGENIC CYST as most of our members have deemed.
    Although a majority of the members have called it GOC, careful observation of the photomicrographs will reveal that it does not fulfill the criteria required for a diagnosis of GOC [Gardner et al & High AS or Koppang et al]. Perhaps the pseudoduct like or cystic appearance within the lining epithelium would have led members to think in terms of GOC. This case can  still be appreciated, even with the limited number of photomicrgraphs provided, as cystic variant of AMELOBLASTIC FIBROMA if one carefully observers the photomicrographs keeping in mind the clues provided – see below.
   The surface lining in GOC can either be cuboidal or columnar or rarely mucous cells. The cells that form the lining of the duct like spaces in GOC are very much similar to the surface cells. The basal cells in GOC is hyperchromatic and vacuolated. Prominent epithelial thickening in GOC is characteristic although not specific. In most cases the epithelium is non-specific but stratified.
     In contrast, if one carefully observes the surface cells in the case 32, they can appreciate ameloblast – like cells with nuclear reversal [photomicrograph 1 second row (right lower field), the lower magnification of the same can be found in the first row, photomicrograph 2]. The other areas represent odontogenic epithelial nests [photomicrographs 2 in the first row and 2 in the second row as well as 3 in the first row, 1 and 2 in the second row] and strands typical of ameloblastic fibroma [photomicrographs 1 in the first row and 3 in the second].
   We once again thank the members for their time and patience.
     Thanking You
Sincerely Yours
Ponniah I
Preeti L
Members Interpretations of the case
Dr. Smitha.T.
Glandular odntogenic cyst

N.Chaitanya babu
For diagnosing odontogenic lesions clinical and radiological findings have to be mentioned clearly in the history which u send, this without proper history appears to be okc

Dr. Dinesh
Odontogenic cyst with Ameloblastic transformation

Dr.N.Govindrajkumar
The given slides shows cystic lining eptihelium showing 6-8 layers thickeness and gladular cells giving a impression of siloodentogenic cyst

Yeshwant B. Rawal
Glandular Odontogenic Cyst.

Dr.Susmita Saxena
Unicystic Ameloblastoma

Mohd Qotb
Classic form of odontogenic keratocyst

Anila Pc
Glandular odontogenic cyst

Dr V K Hazarey
Glandular Odontogenic Cyst

Dr.Shajahan
It is odontogenic keratocyst  i have not seen this much surface corrugation before

Sunil S
Cystic ameloblastoma

Dareen Mohamed
Dentigerous cyst

Mei Syafriadi
It seem likes Odontogenic keratocyst (OKC)

Jaana Hagstrom
Glandular odontogenic cyst

Dr.K.Karunakaran
Flat lower border , duct like structures of epithelial arrangement extending in to the lumen suggestive of glandular odontogenic cyst. confirm the presence of mucus cells with mucicaramine stains

Mario Nava
Glandular odontogenic cyst (sialo-odontogenic cyst)

Elias Romero
Glandular  Odontogenic  Cys 

Elias Romero
Quiste  Odontogenico  Glandular

Sivapathasundharam
Photomicrographs suggestive of calcifying odontogenic cyst                                                                  ▲Top
 

Case 33:  A 60-year-old female presented with a painless growth over the right buccal mucosa of 3 months duration. History revealed that the growth gradually increased to the present size, measuring 1.5x1 cm in diameter. Her past medical history was not significant. On examination, an indurated ulcer was present in the buccal commissure extending to the lower lip. There was no associated lymphadenopathy. A provisional diagnosis of squamous cell carcinoma was made. The lesion was excised and sent for HP examination.
Click here for photomicrographs

Members Interpretations of the case

Dr Madhusmita Jena
I think this is a case of "Polymorphous low grade adenocarcinoma of minor salivary gland duct" (PLGA). However, more photomicrographs would have made the diagnosis conclusive.

Elias Romero
Salivary  Duct  Carcinoma

Dr.N.Govindrajkumar
Adeno-carcinoma.

Darunee
According to the pictures and your description, I think about salivary duct carcinoma 

Fabian Ocampo
PLGA

Ronald L. Katz, DMD
Adenoid cystic ca?

Dr.Susmita Saxena
Ductal papilloma of salivary gland with squamous metaplasia

Sook woo
Looks like an adenocarcinoma

Fábio Pires
Polymorphous low-grade adenocarcinoma
Rule out metastasis

Charles E. Tomich
I would diagnosis this as a papillary cystadenocarcinoma.

Mario Nava
Micropapillary Cystadenocarcinoma, rule out primary tumour of breast or lung? I not believe that ductal hyperplasia have been associated with the neoplasia.

Carl Allen
This appears to be an adenocarcinoma, either primary salivary origin (adenocarcinoma, NOS) or a metastatic deposit. Given the mitotic rate, I would tend to favor metastatic disease.

Craig Fowler
Poorly differentiated adenocarcinoma, rule out metastatic lesion

J. fantasia
C/w papillary acinic cell adenocarcinoma

Dr.Kraisorn Sappayatosok/ Dr. Kittipong Dhanuthai
Papillary cystadenocarcinoma

Jaana Hagström
Could it be adenocystic carsinoma or cystadenocarsinoma (papillary growth)

Gerardo Meza
Cystadenocarcinoma papillary

Benjamin Martinez, MS
Adenocarcinoma, NOS. Rule out metastatic adenoca from lung, stomach, etc.

Dr.CSBR.Prasad
Metastatic deposits from an adenocarcinoma.

N. Chaitanya babu
In the history patients tobacco chewing habit has not been mentioned. if it is not associated with tobacco chewing habit it appears as keratoachanthoma.                                                                                                                   ▲Top

Case 34:   A 50 yr old male patient reported with the chief complaint of growth in the lower front region since 15 days. Growth started 15 days back as a small swelling and progressed to present size. On intraoral examination, a pedunculated mass was found in gingiva i.e. 33 and 34. The growth was rectangular in shape, 1.5X1cms in size, red in color and soft in consistency and was attached to underlying bone. Medical and family history was not relevant and patient smokes 10-12 cigarettes per day since 30 years. No other investigations were carried out by surgeon and a provisional diagnosis of inflammatory pyogenic granuloma was given.
Click here for photomicrographs

Members Interpretations of the case
Vijay Wadhwan
Looks like a metastatic tumor. Go for the whole body scan

Charles E. Tomich
I think it is metastatic disease.

T.R.Gururaja.Rao
Suggestive malignant transformation. Diagnosis - Acinar cell carcinoma

Roger
We think an metastatic adenocarcinoma, maybe, lung, prostate gland or mamary

Supriya Koshti
Adenocarcinoma

D Jintakanon
Metastatic melanoma is suspected, HMB 45 and tyrosinase stain are recommended. The other possibility is metastatic undifferentiated large cell carcinoma.

Sheema H Hasan
Malignant epithelial tumour probably minor salivary gland origin. Acinic cell carcinoma, intercalated ductal type is a possibility

Sergio Castro
It looks like a metastatic carcinoma of the lung

Susmita Saxena
Large size of cells and granular cytoplasm is suggestive of granular cell myoblastoma, though rare in that site but reported.

Rajini
Looks like a metastatic lesion.

Beatriz Catalina Aldape Barrios
metastasic adenocarcinoma

Mario Nava
Metastasic adenocarcinoma. (Search primary tumor in prostate)

Fábio Pires
Metastatic adenocarcinoma

Gerardo Meza
Metastasic adenocarcima

V V Kamath
Looks like glandular lesion... lots of granular cytoplasmic hyperchromatic cells arising from ductal area... most likely oxyphlic adenoma... but site is disturbing.. If correct then think metastasis and do workout

Jaana Hagström
Rule out melanoma malignum, plasmacytoma and Lymphoma with immunohistochemistry (S-100, CD138, CD45, AE1/AE3)

Shajahan
The given photomicrograph suggestive of basal cell adenoma
Kindly do some marker for salivary gland pathology

Elias Romero
Metastatic Adenocarcinoma. Primary - Lung

R Melrose
Metastatic carcinoma suspect/rule out hepatocellular carcinoma. Does patient have a history of hep B or C or cirrhosis?

Lakshmanan
The clinical and histopathology is suggestive of pyogenic granuloma

Mehraj shams
Mucoepidermoiid carcinoma (high grade)

Carl M. Allen
Poorly differentiated adenocarcinoma, probably metastatic

Kurt Summersgill
Adenocarcinom, nos.
Without the duct-like structures, I would consider melanoma and lymphoma. A large panel of immunohistochemical stains would help!

Fantasia
metastatic adenocarcinoma

Benjamin Martinez R, MS
Metastatic adenocarcinoma, probably of lung.

Sivapathasundharam B
The section is made up pf infiltered epithelial cells in the form of sheets. Many areas show ductal/ adenoid pattern with acantholytic cells in side the lumen, suggestive of adenoid squamous cell carcinoma

Rafik Abdelsayed
Most likely a metastatic disease, suspected a melanoma

Joaquín Urbizo
Adenocarcinoma vs. malignant melanoma

Dareen
oncocytoma

Vinay Hazarey
Acinic cell carcinoma

J. Sciubba
Basaloid squamous cell carcinoma

Ney De Araujo
1-Metastatic tumor 2Malignant Salivary gland tumor; first choice Acinic Cell Carcinoma. Immunostains are necessary.

Yeshwant B. Rawal
Metastatic Carcinoma (Very suggestive of hepatocellular among others).Rule out Melanoma and other epithelioid sarcomas.                                                                                                                                                   ▲Top

Case 35:
       A 50 yr old male patient reported with the chief complaint of swelling in the right upper back tooth region since 3 years. Growth started initially as a small swelling and progressed to present size. Pain in the area is intermittent in origin and is associated with bleeding. On intra oral examination, a nodular swelling was present in the palatal aspect of 16 and 17. The growth was rectangular in shape, 2x3cm in size, red in color and soft in consistency and was attached to underlying bone. It was tender on percussion and bleeds on probing. Medical and family history was not relevant. Patient was occasional smoker.
       Extra orally, a diffuse reddish patch was seen on the right half of face, not crossing the midline and a diffuse swelling was seen on the upper lip crossing the midline. Blood investigations showed normal values and angiography impression was normal. Incision biopsy from the palatal mucosa in relation to 16 was submitted for histopathology.
      We would like to know whether this intraoral lesion is associated with cutaneous face and lip lesions and whether the histopathogical findings fit into the acquired tufted angioma diagnosis (variant of capillary hemangioma).
Click here for photomicrographs

Members Interpretations of the case
Manisha Sardar
Lesional tissue is not that clear may b suggestive of cappillary hemangioma

D Jintakanon
I agree with you that the lesion fits to acqired tufted angioma

Sachin Sarode
hemangioma,

Rajiv Desai
mature hemangioma

Susmita Saxena
Suggestive of Haemangioendothelioma

N.Govindrajkumar
Its schwannoma i dont think it has any association with cutaneous face and lip lesions

A.Zahi Shawaf
I think the diagnosis is cellular hemnagioma but present of hemosiderin pigmentation and other spindle cells give aspect Kaposi type agiomatous lesion

Mario Nava
I agree with your diagnosis, and I believe too, that your association is correct.

T.R.Gururaja Rao
It is a variant of cpillary hemangioma ,manifested on the lip as well as on the palatal aspect.In some siuation the lip is swollen which presents as a tumor like lesion.(PORT WINE STAIN APPEARANCE

Vivek Pakhmode
Hemangioendothelioma or Hemnagiopericytoma

Nadim M Islam
Glomangiopericytoma

Lewei Zhang
Looks inflammatory to me. Any local factor could explain this lesion?

Al Munawir, MD
Hemangioendothelioma

Dileep Sharma CG
Sir, This is a case i happened to examine about a year and a half ego in GDC, Bangalore. We provisionally diagnosed it to be a A-V malformation as it is unilateral. He was scheduled for a angiogram but did not turn up for the same fearing an extensive surgery. Also a complete body examination will show similar kind of patches on his back and chest region (Please examine). An opinion with a Vascular surgeon to find the exact location of the A-V Malformation is suggested before any surgical treatment is planned. I was surprised that you don't seem to have any incidence of excessive bleeding during biopsy as we were strictly warned against such an attempt as it might be risky for the patient. We also ruled out some syndomes associated with port-wine stains like Osler-Weber-Rendu Syndrome which show unilateral hemangiomas and similar conditions.
Ultimately it was diagnosed as just an A-V Malformation.                                                                              ▲Top

Case 36:
        A 70 year old male reported with a swelling on right side of face. Patient noticed a small swelling two months back of a size of pea in the lower anterior region of mouth. Within two months it attained the present size and is not associated with pain. Obliteration of eye was observed since one month but the vision was normal. Regional lymph nodes were palpable.
Click here for photomicrographs

Members Interpretations of the case
Madhusmita Jena
Section shows slit like spaces lined by atypical endothelial cells with some of them showing epitheloid appearance with some cells of atypical mitosis. Suggestive of Angiosarcoma of oral cavity.

Satish Yadav T
Metastastic carcinoma

Ambrish Kaushal
verrucous carcinoma

Dinakar
Hithanks for the intresting case.was any spl stains for Rhabdomyosarcoma done.pls keep meinformed.

Anila
seems likely to be a metastatic tumour

Belgaum Oral Path
1) Alveolar soft tissue sarcoma
2)malinant nerve tissue tumor
3)Fibrosarcoma

Indraneel Bhattacharyya
High grade spindle cell malignancy needs immunohistochemical stains for further differentiation

Mario Nava
The immunohistochemistry would be really helpfull. It's complicate, sorry I have several possibilities. Sinovial Sarcoma Fusiform Cell Carcinoma Dendritic Cell Sarcoma (interdigitant or follicular) Malignant peripheral nerve sheath tumor even linfoma or PNET (I can see rossetoid structures).

Antonio Santiago
también incluyo el dx de carcinoma poco diferenciado

Antonio Santiago
Hay unas fotos que me hacen pensar en linfoma, me parece que se observa un pseudofolículo, también creo que puede ser un sarcoma sinovial con predominio monofásico a descartar con inmunohistoquímica

Rakesh
Connective tissue malignancy, probably MPNST. IHC needs to be done.

Mahija
Malignancy arising from connective consisting of both spindle cells and epithelioid cells.Some areas are suggestive of a nerve origin.Can it be MPNST?

Alberto Peraza
it´s look like a mesenchimal lession with irregular mitoses and a small component of ephitelial cells, it´s a fibrosarcoma but it would be nice a closer view of the biopsy

Fabian Ocampo
Although the patient's age don't fit, could be a pleomorphic type of rhabdomyosarcoma.

Smitha.T
Spindle cell carcinoma/sarcomatoid carcinoma

Sunitha Carnelio
It seems like an aggressive connective tissue neoplasm
Please do special stains like retics,PTAH,PAS.Further out come of the results can subject to IHC markers

Sook Woo
Sarcoma. YOu will need immunohistochemistry for a definitive diagnosis.

Charles Tomich
It is obvious that we need immunohisto-
chemical help on this case. I would do markers for keratin, a vimentin, LCA, and S-100 to start. If any are positive, I would go further in my panels. From purely the H&E level, I would think of a sarcoma, possible a MPSNT
(malignant peripheral nerve sheath tumor).

Manisha Sardar
metastatic tumor

Ilana Kaplan
poorly differentiated sarcoma is what it looks like
IHC?

Nadim Islam
pleomorphic rhabdomyosarcoma

Andisheh
Malignant fibrous histiocytoma

Susmita Saxena
Malignant Fibrous Histiocytoma

Mehraj Shams
fibrous histiocytoma

Kalu U.E. Ogbureke
Malignant mesenchymal neoplasm suggestive of osteosarcoma (fibroblastic vs osteoblastic) stain for osteoid production by tumor cells.

Elias Romero
Leiomyosarcom

Bernardo Cruz
Looks like a melanoma

Barasch
fibrous displasia

Darren P Cox
Sinonasal undifferentiated carcinoma

Jose M. Aguirre
Malignant Fibrous Histiocytoma

Gerardo Meza
Malignant fibrous hystiocitoma, needs inmunohystochemistry

Douglas Gnepp
Malignant neoplasm most consistent with malignant fibrous histiocytoma pending immunohistochemistry to rule out other sarcomas, sarcomatoid carcinoma and melanoma

Fantasia
HIGH GRADE SARCOMA - FAVOR FIBROBLASTIC OSTEOSARCOMA, NO OSTEOID IN SECTIONS YET X-RAY REVEALS MINERALIZED AREAS WHICH MAY DEMONSTRATE OSTEOID

Kernig
Spindle cell carcinoma (sarcomatoid carcinoma); AE1/AE3, vimentin, CK5/6

Manal Alsheddi
could be synovial sarcoma                                                                                                                               ▲Top

Case 37:  A 65-year old male presented with a painless gradually enlarging swelling on the left side of the cheek of 3 months duration. He also reported nasal obstruction and regurgitation (Fig 1).  [fig 2, three weeks after initial presentation]

There was no history of high fever. His personal history revealed that he is a tobacoo (betel quid) user for the past 45 years [15 times/day]. His past medical history revealed that he underwent radiotherapy (30 gy/3#/1000 cgy per fraction) 7 years back for a malignant lesion (Plasmacytoma) in the tonsillar region with secondaries in the right neck. Except for this information, no other relevant past medical details was elicitable.

On examination, a well defined smooth surfaced swelling over the left maxillary region extending from the anterior border of the ramus to the left lateral wall of the nose, superiorly, it extends to the infraorbital margin. Nasal septum is deviated. Lymph node examination of the body failed to reveal palpable nodes. Abdominal examination failed to reveal palpable mass. On intra oral examination, a nodular growth was seen in the left maxillary alveolus extending from the left maxillary canine to the tuberosity. [medially, to midline raphe and laterally, to the left buccal sulcus].

Computed tomography (CT) showed evidence of soft tissue density lesion in the maxillary sinus involving the orbit, left nasal cavity, ethmodial sinus, sphenoidal sinus, cheek and intratemporal fossa. CT also revealed erosion of the left inferior orbital plaste, alveolar process of maxilla, medial orbital wall and lateral nasal wall (fig 3). Laboratory findings showed white blood cell count (total and differential) within normal limits, ESR-22mm/hr and Hemoglobin-10.0 gms%. Peripheral smear showed normocytic and hypochromic anemia.
Click here for photomicrographs
Members Interpretations of the case
Gerardo Meza
Malignant fibrous hystiocitoma

Prathamesh Satish Joshi
Malignant salivary gland tumour

Siva
Carcinoma Ex Pleomorphic Adenoma
or
Lymphoma

Rakesh
Malignant round cell tumor. The plump proliferating cells may be endothelial cells.

Mahija Janardhanan
The photomicrograph shows malignant round cells which r pleomorphic.Some of these cells show attempted vascular lumina formation(typical signet ring pattern) and hence is suggestive of Malignancy of vascular origin...Hemangioendothelioma.

Jaana Hagström
Acantolytic squamous cell carcinoma.
You should rule out malignant melanoma, lymphoma and plasmacytoma.

Gururaj
It may be a hodgkin's lymphoma

Shivani
histopathological features r compatible with previous diagnosis of plasmacytoma.

Susmita Saxena
Possibility of chondrosarcoma

Smitha.T.
Angiocentric T-Cell lymphoma

Joaquín Urbizo
Pleomorphic liposarcoma

Antonio Santiago
Rabdomiosarcoma Alveolar

Rahul B Patil
Nasopharyngeal carcinoma OR Non- hodgkin's lymphoma (Extra Nodal) Need immunohistochemistry.

Mario Nava
Pleomorphic Lymphoma vs melanoma (even malignant fibrous histyocitoma)

Dareen Mohamed
histiocytosis

Govindrajkumar
Anaplastic lymphoma ?
IHC is required to rule out other round cell tumours

Vinay Hazarey
Liposarcoma Highly Malignant Blastic

Faraz
Sq cell ca

Fisnik Kurshumliu
Myoepithelial carcinoma

Mohamad zakarya
I think it is sqamous cell caecinoma in maxillary sinus

Atilio Silva
Alveolar rabdomiosarcoma

CSBR.Prasad
My differentials are Anaplastic large cell lymphoma and Rhabdomyosarcoma. Immunos are needed to differentiate.

Yeshwant Rawal
The differential may include melanoma, Lymphoma (lymphoplasmacytic), and rhabdomyosarcoma

Anila
Secondaries or may be a primary plasmacytoma

Sahar Riad
It is highly malignant and for me it looks more like an adenocarcinoma. A second opinion is a chondro sarcoma.well i am not positive.

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Case 38:  A 45 year old male reported with a swelling on left side of face. Patient noticed a small swelling three months back in the cheek region which gradually increased in size. The diffuse, firm swelling extended from 2cms below the infra orbital rim to the level of ala tragal line and anteroposteriorly about 1cm lateral to nose to about 3cms posteiorly. No associated signs and symptoms and regional lymph nodes were not involved. No history of habits and no other clinically significant history.
          OPG showed haziness of the left maxillary sinus.
          On surgical exploration the tumor was seen infiltrating the lateral wall of the nose and posteriorly into the maxillary sinus area.
          Large soft tissue specimen and two small infiltrating soft tissue bits were received from left maxilla along with extracted 23, 24, 25 and 26. Grossly the specimen was well encapsulated, pebbly surfaced and measured 5x4cm. Cut surface was gitty, showed grey white and haemorrhagic areas with multiple cystic spaces. On rupturing papillary surfaces necrotic exudate was seen oozing out.
Our difficulty in this case: Tumor islands of variable sizes were seen showing central areas of comedo necrosis. Tumor cells surrounding the necrosis showed cribriform pattern with small cystic spaces. Small solid islands/ nests of tumor cells were seen invading into the deeper areas. Should we categorize this as salivary duct carcinoma or adenoid cystic carcinoma with comedo necrosis.
Click here for photomicrographs
Members Interpretations of the case
George S Kaleebi
The cytomorphology and the cribriform structures are reminiscent of adenoid cystic carcinoma. I have wondered if some of the cells lining the smaller spaces are not in fact mucous producing cells, but these are indeed very few. I would not diagnose salivary dact carcinoma on the basis of comedo necrosis alone, without high grade atypia. Low grade salivary duct carcinoma has been described, but it does have cellular projections. My vote is on adenoid cystic carcinoma with comedo- like necrosis.

Adisheh
salivary duct carcinoma

Marco Torres
I do agree with Adenoid cystic diagnosis

Gerardo meza
adenoid cystic carcinoma with comedo necrosis, but needs inmunohystochemisry

Shailja chatterjee
this is a case of terminal duct carcinoma as such large areas of comedonecrosis is not a feature encountered in adenoid cystic carcinoma

Manisha sardar
salivary duct carcinoma

Sylvia
Salivary duct carcinoma

Joaquín Urbizo
Adenoid cystic carcinoma with comedo necrosis

Prajakta zade
terminal duct carcinoma

Ashish Bodhade
There is lot of commedonecrosis, other fetures appears to be of adenoid cystic carcinoma, but together cosidered it is found to be case of Turminal Duct Carcinoma.

Dinakar, coimbatore
considering inflammmatory component,was any special stains done to find out fungal and parasitic infestions

Mehraj shams
SALIVARY DUCT CARCINOMA

Charumiglani
Yes I will go with adenoid cystic carcinoma with necrosis

Madhusmita Jenajena
Salivary duct carcinoma can have similar histology

Sook-Bin Woo
Salivary duct carcinoma

Madhusmita Jena
I think it is adenoidcystic carcinoma.

T.R.Gururaja.Rao
it is a case of salivary duct carcinoma with comedo necrosis

Narayan
Adenoid cystic carcinoma

Sheema h hasan
My diagnosis is Salivary duct carcinoma. This may have a cribriform pattern just like ductal carcinoma breast.

Elias Romero
Salivary duct carcinoma

Abhay Chandak
Adenoid cystic carcinoma with comedo necrosis

Susmita Saxena
Multiple cystic spaces are suggestive of Adenoid cystic carcinoma

Maryam Khalili
Considering the histopathologic pattern and cellular differentiation in addition to the comedonecrosis , in my opinion this lesion could be classified as salivary duct carcinoma rather than ACC

Mario Nava
Adenoid Cystic Carcinoma with abundant comedo-necrosis, the cytologic features are the base of my consideration.

Soussan Irani
The comedonecrosis areas help to differentiate Salivary duct carcinoma from adenoid cystic carcinoma

Vivek pakhmode
ACC

CSBR.Prasad
Salivary duct carcinoma

Prof Vinay Hazarey
Adenoid cystic carcinoma.Very good gross specimen

Beatriz Catalina Aldape Barrios
adenoid cystic carcinoma

Ajay Telang
from the photographs posted on the site it looks more in favour of a salivary duct carcinoma.

Yeshwant Rawal
Salivary duct carcinoma. In addition to the large islands, comedo necrosis and roman bridging producing a cribriform appearance helps. Also, in cystic and comedo necrosis struck areas, viable tumor cells present as a thin rim.

Ponniah I
FIRST ROW: The photomicrograph (03) on the first row shows many large cystic spaces in the given field with few neoplastic islands virtually in vascular spaces of an otherwise vascular stroma. The photomicrograph (04) shows comedonecrosis and and cribriform island as well as an island that appears to be intraductal but the clarity of the photomicrograph did not permit clear assessment, nonetheless, the island shows more vascularity and central cystic changes.

SECOND ROW: The photomicrographs in the second row characteristically show prominent but delicate vascular spaces as well as so-called cribriform areas. The photomicrographs in the third rows shows apparent cribriform areas but it is not clear whether the cells making up theses areas represent a high-grade cytology normally expected in a case of salivary duct carcinoma.

CONCLUSION: The prominent vascularity of the stroma in addition to the apparent comedonecrosis and cribriform areas may well suggest a diagnosis of salivary duct carcinoma but the extreme vascularity preclude a diagnosis of adenoid cystic carcinoma. On the other hand, the cystic changes noted both marcoscopically and microscropically together with pseudocribriform areas and extremely high vascularity would strongly suggest the possibility of canalicular adenoma, nothwithstanding, that canalicular adenoma is more common in the upper lip than in the area mentioned in the case report with infiltrative features. In my opinion, I would explore more blocks to find out the features required for a diagnosis of canalicular adenoma and to appreciate whether a transitional area representing high-grade cytology can be found to ascertain the possibility of de-differentiation or otherwise.

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