case_images: PMC11126263_01
case_images: Extraoral (a) and intra-oral (b) clinical presentation
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case_images: The swelling appeared round to oval in shape [Figure 1a]. It measured approximately 2x3 cm in size with well-defined margins and colour the same as that of the surrounding mucosa [Figure 1b].
case_images: Orthopantomogram (a) and CT scan (b)
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case_images: The lesion extended antero-posteriorly from the root apex of 34, till 38, involving the body and ramus of the mandible, whereas supero-inferiorly it extended from apical 1/3rd of the root of 36 and 37 till 1.5 cm towards the lower border of the mandible measuring approximately 3x5 cm in size [Figure 2a]. The inferior alveolar canal could not be appreciated within the lesion [Figure 2b].
case_images: Hemimandibulectomy specimen (a), specimens collected from different sites (b), loose fibrillar mucoid stroma with stellate cells and few capillaries (H&E stain; 4x, 40x) (c and d)
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case_images: Based on the above findings, an excisional biopsy was performed and one hemimandibulectomy specimen extending from the midline to the left condylar area with associated teeth and soft tissues was received [Figure 3a]. Tissues were harvested from multiple sites [Figure 3b] for histopathologic evaluation, and the submitted H&E-stained sections revealed abundant loose mucoid stroma containing rounded, spindle-shaped or angular cells, which were evenly spaced within the fibrillar matrix. A few mild chronic inflammatory cells and delicate capillaries lined by endothelial cells were also evident [Figure 3c and d].
case_images: Alcian blue stain in control and case (a and b); PAS stain in control and case (c and d)
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case_images: The tissue was then subjected to Alcian blue [Figure 4a and b] and periodic acid schiff (PAS) staining [Figure 4c and d] to confirm the nature of the ground substance, that is, hyaluronic acid and chondroitin sulphate.
case_images: Alpha-SMA in control and case (a and b); S100 in control and case (c and d)
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case_images: The lesions were then ruled out based on their histopathology [Table 2] and through confirmation of immunohistochemical staining for alpha-smooth muscle actin (SMA) [Figure 5a and b] and S100 [Figure 5c and d] for myxofibroma and myxoid neurofibroma, respectively, as the staining was negative, thereby confirming a true myxomatous origin of the lesion.