case_images: PMC8105109_01
case_images: Ultrasonography shows a well-defined hypoechoic heterogenous mass lying between the skin and buccinator muscle.
case_images: CRID2021-9940304.001.jpg
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case_images: fig1
case_images: The results of ultrasonography indicated a well-defined hypoechoic heterogeneous mass lying beneath the skin measuring 13*18 mm (Figure 1).
case_images: Coronal MDCT image shows a circular well-defined homogenous mass in the right buccal area.
case_images: CRID2021-9940304.002.jpg
case_images: PMC8105109_01_CRID2021-9940304.002.jpg
case_images: fig2
case_images: MDCT showed a circular well-defined homogenous mass over the buccinator muscle (Figure 2).
case_images: (a) Axial T1 MRI shows a low signal homogenous mass in the right lying over the buccinator muscle and under the skin. (b) Axial T2 MRI shows the lesion as high signal and homogenous.
case_images: CRID2021-9940304.003.jpg
case_images: PMC8105109_01_CRID2021-9940304.003.jpg
case_images: fig3
case_images: T1 sequence showed a well-defined low signal mass between the buccinator muscle and buccal fat (Figure 3(a)). The MRI T2 sequence showed that the mass is homogenous and high signal (Figure 3(b)).
case_images: Intraoral incision on the buccal mucosa revealed a spherical lesion just underneath the buccinator muscle.
case_images: CRID2021-9940304.004.jpg
case_images: PMC8105109_01_CRID2021-9940304.004.jpg
case_images: fig4
case_images: Upon obtaining consent, an excisional biopsy was performed under local anesthesia and incision was made on the buccal mucosa just over the palpated mass (Figure 4).
case_images: Image shows gross specimen, a spherical brown-gray firm tissue, measuring 1 cm in diameter.
case_images: CRID2021-9940304.005.jpg
case_images: PMC8105109_01_CRID2021-9940304.005.jpg
case_images: fig5
case_images: The lesion was completely excised (Figure 5).
case_images: (a) Thin blood vessels with papillary projections in the fibrous stroma (x40). (b) Paralleling pattern of fascicle and glomus cells around the blood vessels (x100).
case_images: CRID2021-9940304.006.jpg
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case_images: fig6
case_images: The thin-wall blood vessels showed papillary projections to the lumen which some had become irregular, large in size, and even sinusoid in some areas (Figure 6(a)). The stroma contains immature spindle-shaped fibroblasts with a paralleling fascicle pattern next to the blood vessels (Figure 6(b)).
case_images: (a) x40 and (b) x100 positive IHC staining for SMA. (c) x40 and (d) x100 positive for desmin.
case_images: CRID2021-9940304.007.jpg
case_images: PMC8105109_01_CRID2021-9940304.007.jpg
case_images: fig7
case_images: In the IHC staining analysis, the specimen was positive for both SMA (smooth muscle actin) (Figures 7(a) and 7(b)) and desmin (Figures 7(c) and 7(d)); however, the microscopic features in combination with IHC findings were consistent with angioleiomyoma diagnosis.