case_images: PMC11164311_01
case_images: (a) MRI of the head and neck shows one large infiltrative enhancing mass arising from the left posterior aspect of the tongue (b), which crosses the midline and extends to the oropharyncous, left parapharyngeal space, left masticator, and parotid space
case_images: ijp-19-107-g001.jpg
case_images: PMC11164311_01_ijp-19-107-g001.jpg
case_images: F1
case_images: A head and neck MRI revealed a large infiltrative enhancing mass originating from the left posterior aspect of the tongue (Figure 1a, b).
case_images: Histologic sections showing a pseudoepitheliomatous hyperplastic epithelium without atypia (a. H&E. x40), lamina propria is diffusely infiltrated by a pauci-cellular, ill-defined neoplastic infiltration with isolated tubular and cord structures (b. H&E. x100). The neoplasm is composed of small cuboidal to spindle bland-looking mitotically inactive cells forming microcystic lumina, frequently filled by eosinophilic secretions, embedded in a partially sclerotic stroma (c. H&E. x600), in close association with minor local salivary glands (d. H&E. x100) showing neural invasion (e. H&E. x400). Deeper portions of the neoplasm mainly consist of signet ring-like cells with bland-looking nuclei, infiltrating interlacing striated muscle bundles (f. H&E. x400)
case_images: ijp-19-107-g002.jpg
case_images: PMC11164311_01_ijp-19-107-g002.jpg
case_images: F2
case_images: Histologic sections demonstrated an ill-defined submucosal neoplastic infiltration composed of relatively bland-looking small cuboidal to spindle-shaped and mitotically inactive tumoral cells containing mildly pleomorphic nuclei arranged in discrete cords, isolated tubules and bilayer strands of epithelioid cells forming micro-cystic lumina frequently filled by eosinophilic secretions, embedded in a partially sclerotic stroma (Figure 2c). The epithelial lining showed pseudoepitheliomatous hyperplasia without atypia (Figure 2a, b). Deeper portions of the neoplasm predominantly consisted of signet ring-like cells with bland-looking nuclei arranged in cords, nests, and small ductal structures infiltrating the interlacing striated muscle bundles of the tongue parenchyma (Figure 2f). The neoplasm was closely associated with minor salivary glands (Figure 2e). All surgical margins were involved and perineural invasion was noted. (Figure 2d).
case_images: By immunostaining, the tumoral cells were positive for CK7 (a. IHC. X400), smooth muscle actin (b. IHC. X100), P63 (c. IHC. X100), and P40 (d. IHC. X200) with a pattern similar to the epithelium-myoepithelium in both superficial and deep portions of the neoplasm
case_images: ijp-19-107-g003.jpg
case_images: PMC11164311_01_ijp-19-107-g003.jpg
case_images: F3
case_images: Ck7 in luminal cells and for smooth muscle actin (SMA), P63, and P40 in non-luminal cells, similar to the epithelium-myoepithelium pattern in many other salivary gland tumors at both superficial and deep portions of the neoplasm as well as signet ring-like cells (Figure 3, a, b, c, d). CD117 (C-kit) was weakly positive in less than 10% of the luminal cells analogous to the normal salivary gland epithelial cells and interpreted as a negative result.