case_images: PMC10545860_01
case_images: Preoperative NMR and PET examinations. (A) Axial view of preoperative NMR scan showing the tumor mass (yellow arrow). (B) PET images revealed a focal hyperfixation area of the left oral floor and two concomitant areas of radioisotope uptake in the left submandibular and unilateral mandibular seat of the lymph nodes.
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case_images: T1-weighted high-resolution isotropic volume examination (THRIVE), confirmed the presence of a single lesion in the left portion of the oral floor involving the unilateral sublingual space ( Figure 1A ). The mass was well delimited and in contact with the mandibular cortex, with no signs of bone infiltration: diameters of 2.4 x 3 cm in the axial sequence, 2 x 2.8 cm in the coronal sequence, and 3. cm in the sagittal sequence. The whole tumor areas were negative for p40 ( Supplementary Figures 1A, B ). Two concomitant areas of radiotracer uptake were also present in the left submandibular (SUV max = 4.9) and ipsilateral mandibular (SUV max = 3.8) lymph nodes ( Figure 1B ).
case_images: Histological features of the lesion. (A) H&E (original magnification 1x). (B) CK7 (original magnification 1x). (C-E) H&E of Low Grade, High Grade (original magnification 10x), and Mixed (original magnification 4x) areas. (F-H) Ki67 staining of Low Grade, High Grade (original magnification 10x), and Mixed (original magnification 4x) areas (H&E original magnification 10x). (I-K) p63 staining of Low Grade, High Grade (original magnification 10x), and Mixed (original magnification 4x) areas. (L-N) S100 staining of Low Grade, High Grade (original magnification 10x), and Mixed (original magnification 4x) areas.
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case_images: The H&E staining revealed the presence of low- and high-grade tumor features ( Figures 2A, C-E ), with different biomarker expression on immunohistochemistry assays. The whole tumor tissue was positive for cytokeratin 7 ( Figure 2B ), while Ki67 staining showed a lower cell proliferation in the low-grade areas with respect to the high-grade counterparts ( Figures 2F-H ). Cells of the low-grade areas showed higher expression of p63 and lower expression of S100 ( Figures 2I-N ).
case_images: Postoperative images of the tumor mass and histological features. (A) Intraoperative photograph. (B) Lesion surgically excised. H&E images show (C) solid (original magnification 5x), (D) cribriform with focal infiltration in the perilesional adipose tissue (original magnification 10x), (E) cribriform and glandular (original magnification 10x), and (F) papillary growth pattern (original magnification 10x). Representative histopathological features: (G) vascular neoplastic invasion (original magnification 20x), (H) comedonecrosis (original magnification 10x), and (I) lymph node metastasis (original magnification 5x).
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case_images: In May 2020, the patient underwent complete parotidectomy and dissection of the level 1 lymph node ( Figure 3A ). The pathology report described a well-delimited solid mass (3.5 x 2.5 x 2 cm, weighing 15 g) ( Figure 3B ), not capsulated and showing marginal foci with infiltrative aspects. The growth pattern was mostly solid ( Figure 3C ), with areas characterized by tubular and cribriform patterns ( Figures 3D, E ), as well as cystic areas with luminal papillary projections ( Figure 3F ). Vascular and perineural invasion were present ( Figure 3G ), together with multiple comedonecrosis foci ( Figure 3H ). Table 2  and  Data Sheet 2 ). The analysis revealed an overlapping stable trend of the curves showed a DeltaTm melting temperature (Tm sample - Tm positive control) >= -3 (unstable markers are considered for a DeltaTm < -3) ( Supplementary Figure 3 ). These results demonstrated the microsatellite stability of the sample.