Srikant N, Yinti Shanmukha Raviteja, Baliga Mohan, Kini Hema
Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Karnataka, India.
Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Karnataka, India.
J Oral Maxillofac Pathol. 2016 Jan-Apr;20(1):129-32. doi: 10.4103/0973-029X.180970.
A 64-year-old male farmer presented with a rapidly progressive swelling of the left mandible since 6 months. The swelling was firm to hard, diffuse, nontender, obliterating the vestibule with paresthesia of lower lip. The cone beam computed tomography imaging revealed an ill-defined, moth-eaten radiolucency with destruction of the buccal and lingual cortical plates. The rapid growth and aggressive behavior of the lesion coupled with guidance from the patient's previous reports from the incisional biopsy and fine needle aspiration cytology warranted a mandibular resection. Microscopic examination showed an encapsulated lesion situated in the connective tissue containing a mixture of proliferating spindle-shaped cells arranged in fascicles and round cells infiltrating into the connective tissue stroma and bone. The neoplastic cells exhibited atypical features such as pleomorphism, hyperchromatism and increased mitotic figures with noncleaved nuclei. A working diagnosis of a spindle-cell sarcoma was arrived at with various differentials provided such as fibrosarcoma, rhabdomyosarcoma, leiomyosarcoma, malignant peripheral nerve sheath tumor, Langerhans cell histiocytosis and lymphoma and stating the need for immunohistochemistry to subtype the tumor. The neoplastic cells were negative for Van Gieson's stain and Masson's trichrome. Immunohistochemical analysis performed using desmin, smooth muscle actin, S-100 and CD1a in a bid to determine the phenotype of the tumor and rule out the previously stated differentials were all negative for the lesion. Lymphoid markers such as leukocyte common antigen and CD20 (cluster differentiation marker for B-cells) showed positivity in spindle-shaped cells as well as round cells indicating the tumor to be a lymphoproliferative lesion of B-cell type. A final diagnosis of "spindle-cell variant of non-Hodgkin's lymphoma" was rendered based on the immunohistochemical profile.
一名64岁男性农民，自6个月前起左侧下颌骨出现迅速进展的肿胀。肿胀质地硬，呈弥漫性，无压痛，使前庭消失，下唇有感觉异常。锥形束计算机断层扫描成像显示边界不清、呈虫蚀状的透射区，颊侧和舌侧皮质骨板破坏。病变的快速生长和侵袭性表现，结合患者之前切开活检和细针穿刺细胞学报告的指导，有必要进行下颌骨切除术。显微镜检查显示，在结缔组织中有一个包膜性病变，包含成束排列的增殖性梭形细胞和浸润到结缔组织基质及骨内的圆形细胞的混合物。肿瘤细胞表现出非典型特征，如多形性、核深染和有丝分裂象增加，核未分裂。初步诊断为梭形细胞肉瘤，同时列出了各种鉴别诊断，如纤维肉瘤、横纹肌肉瘤、平滑肌肉瘤、恶性外周神经鞘瘤、朗格汉斯细胞组织细胞增多症和淋巴瘤，并指出需要进行免疫组织化学检查以对肿瘤进行亚型分类。肿瘤细胞对Van Gieson染色和Masson三色染色均为阴性。为确定肿瘤表型并排除之前所述的鉴别诊断，使用结蛋白、平滑肌肌动蛋白、S-100和CD1a进行免疫组织化学分析，结果显示病变均为阴性。淋巴细胞标志物如白细胞共同抗原和CD20（B细胞的簇分化标志物）在梭形细胞和圆形细胞中均呈阳性，表明该肿瘤为B细胞型淋巴增殖性病变。根据免疫组织化学特征，最终诊断为“非霍奇金淋巴瘤梭形细胞变异型”。
