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. [No pre-operative biopsy was done].

        Histopathological examination of excised specimen was examined routinely. The lesion microscopically was made of gland-like proliferation characterized by long, slender filiform micropapilla with secondary and tertiary tufts but without a connective tissue core projecting into a cystic space. The cells that lined up the papilla are large cuboidal cells, the nuclei of which showed dispersed chromatin and prominent nucleoli. Increased mitotic figures, more than 5 per high power field were found Figure [A, B, C].
        In other areas, the papillary growth emanated from a broad connective tissue core in a non-hierarchical manner. The connective tissue showed fibroblastic response in these areas Figure [D]. There was also a small solid nest surrounded by cleft or space Figure [E & F] (arrow). Invasion of adjacent skeletal muscle
was also found Figure [F] (arrow head). Solid gland-like areas with pseudocribriform growth pattern were also noted. The adjacent normal salivary gland lobules were uninvolved, but atypical hyperplasia (?) was observed in an excretory duct away from the main lesion Figure [G].
        I would like to know the histological diagnosis of this lesion and also whether the microscopic interpretation was right or not. If the interpretation is wrong, kindly give me the right interpretation based on the photomicrographs provided.


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A

B

C

     

D

E

F

     

 

 

G

 

 

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