Section I of Interesting Cases

Section I:
Case 1: Case 2: Case 3: Case 4: Case 5: Case 6: Case 7:

Section III: Cases from 14 -21.
Section IV: Cases from 22 - 28
Section V: Cases from 29 onwards

A 16 year old female reported for evaluation of a neck mass of 8 months duration, painless slowly increased in size to the present 1x1cm extraoral firm swelling in the left submandibular region anterior to the massetric insertion without surface erosion and/or encrustation, isolated and non-pulsatile. The neighbouring teeth tested positive for vitality. No clinical caries/periodontal decay noticed.

For photomicrographs of this case contact: info@teleoralpathology.com

Diagnostic Interpretations of this case by Members:

1. Sook Bin Woo

I don,t think that the photomicrographs and/or specimen are necessray representative. You describe a 1cm mass but I only see fibrovascular tissue.

2. Susan Zunt

Looks like hemangioma, although I cannot determine the significance of the lymphocytic presence.

3. Paul Freedman

Intranodal Haemangioma.

4. T. R. Gururaja Rao

Lesions appears to be originating from the connective tissue shows presence of hyalinized or myxoid tissue and fibroustissue suggesting myxofibroma - shows inflammatory reaction with epithelioid cells suggesting tuberculous lymphadenitis. However history is inadequate for diagnosis.

5. Govindraj Kumar

The given slide shows a discontinous surface epithelium and underlying connective tissue shows increased number of blood capillaries and chronic inflammatory cell infiltrate predominantly lymphocytes and dense collagenous tissue.

Chronic inflammatory pathology.

6. Peter gallagher

Seems like an interesting lesion, lots of endothelial proliferations & lymphocytes. Could be hemangioma or/but the lymphocytes suggest - Angiolymphoid hyperplastic lesion.

7. AW Barrett

These sections are not diagnostic. They raise the possibility of an arteriovenous hemangioma, but little else.

Our histopathologic interpretation of the case:

Angiolymphoid hyperplasia with tissue eosinophilia (ALHE)

Clinically and histologically similar to Kimura's diasease but a definite entity.

Histologic findings:

The section shows proliferation of small blood vessels, many of which are lined by enlarged endothelial cells with the uniform ovoid nuclei and intracytoplasmic vacoules. The endothelial cells were distinctive and had a cobblestone appearance. In addition a perivascular and interstitial infiltrate composed primarily of lymphocytes and eosinophils was present. Eosinophils typically comprise 5 to 15% of the infiltrate. Lymphoid aggregate with and without follicle formation were noticed at different fields.

The histologic impression was compatible with Angiolymphoid hyperplasia with tissue eosinophils (ALHE).

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Case 2:

A 34 year old woman reported with a history of painless swelling of the right buccal mucosa since 8 months. Her Medical history was uneventful. The overlying area of oral mucosa was diffusely induarted measuring 3x2 cm. with no surface ulceration. The pulp vitality test of the filled teeth was positive and Intraoral periapical radiographs were normal. No history of parotid salivary gland disease. There were no other clincal findings.

For photomicrographs of this case contact: info@teleoralpathology.com

Diagnostic Interpretations of this case by Members:

1. Ricardo Padilla

The quality of the photographs is poor. However it looks like the wall of a nematode.

2. AW Barrett

Some sort of parasite.

3. Morco Torres

This is a worm, could be a larvae of some arthropod or the kind of worms that live in muscle like cysticerus or larvae migrans.

4. CSBR Prasad

Filariasis.

5. Vinay Hazarey

Filarial worm infestation - Filariasis.

6. Constantino Ledesma

No comments. Photographs in my opinion do not permit an accurate microscopic diagnosis or I can't see it.

7. Sook Bin Woo

Parasite ( Filaria )

8. Daniel Quizada Rivera

Seems to me like a prick of fish, may be with a severe inflammatory response and necrosis.

Our histopathologic interpretation of the case:

Histological examination of the lesion shows intense granulomatous inflammation with dilated & tortuos lymphatic (lymphangiectisis). The granuloma was infiltrated predominantly by matured lymphocytes & macrophages with scanty eosinophils indicating a indolent lesion. The diagnostic feature was the presence of disintegrating adult filarial worm surrounded by severe inflammatory reaction. The histologic appearance suggested lymphatic Filariasis.

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Case 3:

A male 21 years old, lesion in the tongue and recurrence after 2 years.

For photomicrographs of this case contact: info@teleoralpathology.com

Diagnostic Interpretations of this case by Members:

1. Vinay K Hazarey

Epithelial myoepithelial carcinoma.

2. Morco Torres

I think this is a pleomorphic adenoma of minor salivary gland, very unusual location.

3. CSBR Prasad

Adenoid cystic carcinoma.

4. Paul Freedman

Adenoid cystic carcinoma.

5. Daniel Quezada Rivera

Canalicular Adenoma.

6. Fabio Pires

Polymorphous low-grade adenocarcinoma of minor salivary glands.

7. Carl T. Hanks

ME Carcinoma.

8. Gary Ellis

Adenoid cystic carcinoma.

9. Shivani Bansal

Adenoid cystic carcinoma.

10. James Cade

Adenoid cystic carcinoma (1st choice)

Polymorphous Adeno Ca

Adenocarcinoma NOS # 1132

11. Finn Praetorius

Adenoid cystic carcinoma

12. Marie Ramer

Salivary gland neoplasm possibly Adenoid cystic carcinoma.

13. Mei Syafriadi

This case showed tumour cell growing from salivary gland, but encapsulated, with duct formation, and eosinophilic hyalin material suggesting Pleomorphic -Adenoma.

14. Ney Araujo

Carcinoma adenoide cistico

15. Kiran Kumar

Sir, the lesion is due to secondary to parasitic infection.

16. G. Sivakumar

Adenoid cystic carcinoma.

Diagnostic Interpretations of this case by Members:

Adenoid Cystic Carcinoma

Infiltrating dark epithelial cell, basophilic nuclei, nest of variable size and shape with a cribriform tubular pattern, sorrounding a stroma fibrous area of hemorrhage. SMA and calpoxin stains spindle cell. In the middle of the tumour as well in the peripheral cells in the tubular regions LEA and EMA strong luminal staining GFAP negative.
We thanks Dr. Douglas Gnepp for his help for this diagnosis.

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Case 4:

Sessile granular mass, 2x1cm. having an encrusted surface. The mass appears friable seen on the outer aspect of the vermillion border of the upper lip, non-tender. Male of 34 years.

Duration: 4 months.

Occupation: Farm laborer.

For photomicrographs of this case contact: info@teleoralpathology.com

Diagnostic Interpretations of this case by Members:

1. Yeshwant B. Rawal

Rhinosporidioma. Sporangia releasing endospores.

2. David W. Nunez

Fungal infection, suggestive of Rhinosporidiosis

3. N Narayana

Rhinosporidiosis

4. Paul Freedman

Coccidioidiomycosis

5. Dr.CSBR.Prasad

Rhinosporidiosis.

6. J. E. Bouquot

The photo is a bit fuzzy, but looks like rhinosporidiosis...is this a satellite from the nose? I cannot

rule out coccidioidomycosis, and even histoplasmosis as a long shot. Need a fungus stain.

7. Dr.Marie Ramer

Coccidioidomycosis

8. Ilana kaplan

Leishmaniasis?

9. Shivani

Kimura's disease.

10. Dr.G.sivakumar

Viral lesions

11. Dr.Govindrajkumar
The given slides shows cells with fungal spores which invaded cells and few spores were also seen out side most probably it might be Rinosporidosis or candida.

12. Fabian Ocampo Acosta

Coccidioidomycosis vs myospherulosis

13. Kumara Swamy K. L

The lesions shows spherules containing multiple nucleas like material busting out. I feel it could be rhinosporidiasis

Our Histopathological Interpretations of the case:

A case of Rhinosporidiosis of the cutaneous lip. Note the sporangia with colonies of rhinospores before eruption.

Impression is Rhinosporidiosis of the facial skin.

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Case 5:

A male 42 years of age. Soft tissue mass of 2x1 cm. right buccal mucosa, 3 months duration. No history of pain, paraesthesia or bleeding from the mass. The overlying mucosa appears normal.

For photomicrographs of this case contact: info@teleoralpathology.com

Diagnostic Interpretations of this case by Members:

Dr. CSBR.Prasad
Malignant fibrous histiocytoma

Mervyn Shear
Histoplasma capsulatum

         N said
                    Without looking at the actual slide, looks like an atypical lipomatous tumor, may be a liposarcoma.
        This will need some immunohistochemical staining to rule out other.

Dr V K hazarey
Oral Histoplasmosis.

Karin Gonçalves
Malignant Peripheral Nerve Sheath Tumor

James Cade
Malignant Fibrous Histiocytoma

Eduardo
Malignant fibrohistiocytic tumor

Ilana Kaplan
Lishmania?

Nelson Lobos

La microfotografia no es muy clara,pero me parece ver prolifracion fibroblastica arremolinada con

cels.gigantes multinucleadas en su espesorespesor. Dx. GRANULOMA PERIFERICO DE

CELS.GIGANTES

Peripheral giant cell granuloma

         Marco Torres
                    The first two slides shows multiple atypia, and in the third seems to be some within the cells.
        Could be a fibrosarcoma.

Sivapatha Sundharam B
Exhibit cellular malignancy suggestive of either malignant schwannoma or rhabdomyo sarcoma

Dr.G.sivakumar
Neurofibroma.

Charu miglani
Giant cell Fibroma.

Roger Kuffer
I think that it is histoplamosis (H. capsulatum)

Dr. Arun Bhardwaj
Looks like Giant Cell Fibroma.

Lia Piperi
Malignant fibrous histiocytoma versus pleomorphic rhabdomyosarcoma

Our Histopathological Interpretations of the case:

                    The tumour mass consisted of dual population of fibroblasts &   macrophages in a storiform pattern that was
       often circumscribed peripherally. Tumour gaint cells were seen. Abnormal & frequent mitotic figures, necrosis & extensive
       cellular atypia were seen, So the impression was compatible with Malignant Fibrous Histiocytoma.

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Case 6:

A female of 33 years. Complains of a slow growing asymptomatic submucosal mass of 6 months
duration on the right buccal mucosa. Size of 2x1 cm.

For photomicrographs of this case contact: info@teleoralpathology.com

Diagnostic Interpretations of this case by Members:

Elias Romero
Neurilemoma

Dr.T.R.Gururaja Rao
This looks to be a case of fibrosarcoma of the cheek mucosa

Dr. Usha Hegde
Connective tissue stroma showing plump fibroblasts & histiocytes & few mitotic figures, suggestive of malignant fibrous histiocytoma

Catherine Poh
Please give more histo with different power. Thanks.
Spindle cell tumor, immuno seeking lesion
D/D 1. inflammatory pseudotumor
2. benign neural tumor (Schwannoma/neurifibroma)

Maria fornatora
Myofibroma

Fabio Ramoa Pires

Leiomioma

Bernardo
It looks like a fibrosarcoma

DR.G.Sivakumar
Benign Muscle Tumor

Oscar toralla
It is a Leiomyosarcoma

Mei Syafriadi
From the slide 1, the tumor mass is higher cellularity with dense proliferation of spindle cell like structures and paralleling arranged. From the slide 2 The nuclei is palisaded, big and long shape with loose connective tissue. suggesting this case is Neurilemoma of the right buccal mucosa

Charles Dunlap
Benign spindle cell tumor, probably myofibroma

Robert Howell
Leiomyoma, but special stains would be helpful

Dr.CSBR.Prasad
Schwannoma-Antony type-A

WM Tilakaratne
Looks like a solitory myofibroma. Leiomyosarcoma should be excluded. Available pictures are not adequate to exclude the possibility.

Dr SC Boy
Differential diagnosis:
1) Solitary myofibroma
2) Solitary fibrous tumour

Dr.Gururaja.Rao
Soft tissue lesion is suggestive of fibrosarcoma of buccal mucosa.

Ilana Kaplan
Schwanomma?
Neurofibroma

Yeshwant B. Rawal
Pictures taken at scanning magnification, areas showing margins of lesion will greatly assist your efforts. Fusiform nuclei and spindle cells with no atypia suggest a benign myofibroblastic tumor. Solitary fibrous tumor may be a differential diagnosis.
Myofibroma/solitary fibrous tumor

Benjamin Martinez
Only two slides for a spindle tumor is very few.
S100 ?
Actin ?
Desmin ?
then my oppinion...

R. Jordan
Probably a myofibroma but I'd have to see the rest of it. Immuno would help.

Stanley Hirsch
WD fibrosrcoma; MFH also deserves consideration

Dr Dinesh
Benign Fibrous Histiocytoma

Dr Hazarey
1)Neurolemmoma
2)Peripheral nerve sheath tumour

Nithya.V
Fibroma

Silvia
Leiomyosarcoma

Gerardo Meza
Low grade fibrosarcoma

DR.N.Govindrajkumar
Fibrosarcoma

Fabian Ocampo
Leiomyoma

Dr. Rajeshwar Chawla
1)Benign fibrous histiocytoma
2)Aggressive fibrous lesion such as nodular facititis

Dr. Deepak
Leiomyoma

Dr. Meghanand
Myxofibromatosis

Raghu Radhakrishnan
It looks like Neurilemmoma.

Our Histopathological Interpretations of the case:

Leiomyoma

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Case 7:

A 40 year old female patient presenting with bony hard swelling of posterior maxilla of 5 years duration. Radiographic findings: A mixed radiolucent-radiodense lesion extending from left canine to third molar region, root resorption of first and second molar is present.

For photomicrographs of this case contact: info@teleoralpathology.com

Diagnostic Interpretations of this case by Members:

Daniel Quezada Rivera
Schwannoma with hyalinization

Priya Munot
Calcifying epithelial odontogenic tumour

Dr.CSBR.Prasad
Cementifying fibroma.

Dr V K Hazarey
Ameloblastoma with dentiniod.(adeniod ameloblastoma)

Meenakshi
Plexiform ameloblastoma

Rafik Abdelsayed
Pindborg tumor?
Limited photomics, but shows what I thought to be amyloid surrounded by rows of epithelial cells

J.Sangeetha
Insufficient photomicrograhs. Evidence of dentinoid material surrounded by odontogenic epithelial cells. Suggestive of odontogenic tumor.

Fabio Pires
Calcifying epithelial odontogenic tumor

Yong Lu
Desmoplastic Ameloblastoma

James Cade
Adenoid Cystic Carcinoma

B. Sivapatha sundharam
(1) Desmoplastic ameloblastoma
(2) Pindborg's tumour

T.V.Narayan
Would like to see some more & better micrographs. On the basis of what is provided it seems to be an odontogenic tumour, with ductal formations & calcification prompting a diagnosis of A.O.T.

Elias Romero
Central Odontogenic (Dentinogenic) Ghost Cell Tumor

Rajeshwar
1)Plexiform ameloblastoma of maxilla with hematogenous component mucoepidermoid carcinoma of the bone (maxilla)

Our Histopathological Interpretations of the case:

Pindborg’s Tumour

Sheaths of polygonal epithelial cells are seen with nuclear pleomorhism in shape, size and number. Mitotic figures were rare. Various amounts of extracellular product believed to be amyloid were also present. The homogenous pale staining eosinophilic material stained positive with Congo red stain. Concentric foci of calcification were seen interspersed with eosinophilic hyaline. Impression was compatible with Calcifying epithelial odontogenic tumour of Pindnorg.

Differential diagnosis:
Adenomatoid Odontogenic tumour. (AOT)
Ameloblastic fibrodontoma
Ossifying fibroma
Osteoblastoma

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