case_images: PMC4065458_01
case_images: Extraoral photograph showing swellings in the left cheek and neck region
case_images: JOMFP-18-97-g001.jpg
case_images: PMC4065458_01_JOMFP-18-97-g001.jpg
case_images: F1
case_images: Skin over the swellings was stretched without any secondary changes but was tender on palpation [Figure 1].
case_images: (a) Compurted tomography scan image showing a mass from the left buccal mucosa extending to the retromolar trigone and involving the submandibular region of the same side. (b) Computed tomography scan picture showing lesion infiltrating mandible
case_images: JOMFP-18-97-g002.jpg
case_images: PMC4065458_01_JOMFP-18-97-g002.jpg
case_images: F2
case_images: Erosion of the alveolar ridge in 36 and 37 region with tooth displacement was also seen [Figure 2].
case_images: Macroscopic photograph of the submitted excised specimen. Inset showing cut surface of submandibular gland
case_images: JOMFP-18-97-g003.jpg
case_images: PMC4065458_01_JOMFP-18-97-g003.jpg
case_images: F3
case_images: The excised radical neck dissection specimen was submitted to us for histopathological evaluation [Figure 3].
case_images: Photomicrograph showing various patterns. (a) Organoid (H&E stain, x100), (b) microcystic (H&E stain, x40), (c) follicular (H&E stain, x40) and (d) papillary cystic (H&E stain, x40)
case_images: JOMFP-18-97-g004.jpg
case_images: PMC4065458_01_JOMFP-18-97-g004.jpg
case_images: F4
case_images: Among the various patterns observed like microcystic, follicular, organoid and papillary cystic; the organoid pattern predominated [Figure 4].
case_images: Photomicrograph showing features of High grade transformation. (a) Increased typical and atypical mitosis (H&E stain, x400), (b) Comedonecrosis (H&E stain, x200), (c) Tumor invasion into the vessels (H&E stain, x400), (d) Nodal tissue replaced by tumor cells (H&E stain, x200), (e) Photomicrograph showing few
  cells positive to cyclin D1 (IHC stain, x400) and (f) Tumor invasion into the bone (H&E stain, x100). Inset showing tumor cells at higher magnification (H&E stain, x400)
case_images: JOMFP-18-97-g005.jpg
case_images: PMC4065458_01_JOMFP-18-97-g005.jpg
case_images: F5
case_images: Few areas showed frequent mitosis and tumor necrosis and tumor cells invading the vessels [Figure 5a-c]. Histopathological typing of the submandibular lymph nodes revealed replacement of the normal tissue by intercalated duct-like cells, few arranged in solid pattern and majority in follicular pattern [Figure 5d]. Invasion of the tumor cells into the bone was also evident [Figure 5f].
case_images: (a) Photomicrograph showing section stained with periodic acid-Schiff and treated with diastase (PAS with diastase digestion stain, x200). (b) Electron microscopic picture showing electron dense secretory granules (G) adjacent to the nucleus (N) of serous acinar cell
case_images: JOMFP-18-97-g006.jpg
case_images: PMC4065458_01_JOMFP-18-97-g006.jpg
case_images: F6
case_images: Demonstration of the diastase-resistant periodic acid-Schiff-positive serous cells in the sections was subtle [Figure 6a]. Though negligible in number, the electron microscopy picture could clearly reveal the serous acinar cells with electron dense secretory granules [Figure 6b].