case_images: PMC11828654_01
case_images: (a) A nodular lesion is present on the skin of the right labial commissure (dashed circle). (b) The intraoral aspects of the lesion cause whitish discoloration of the buccal mucosa (dashed circle).
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case_images: fig1
case_images: The clinical examination revealed a rubbery, firm, mobile, 1.5-cm nodule in the face near the right labial commissure (Figure 1(a)). Intraoral examination showed that the lesion caused a well-circumscribed, whitish macule in the buccal mucosa (Figure 1(b)).
case_images: Surgical procedure showing the segment of the angular artery affected by the atherosclerosis (black arrow).
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case_images: fig2
case_images: During the intraoperative exploration, the surgeon noted that a segment of the angular artery at its junction with the superior labial one was hardened, and no epidermoid cyst was detected (Figure 2).
case_images: (a-d) The H&E staining reveals a notable thickening of the intima, accompanied by the presence of cholesterol accumulations containing foam cells and a minor population of smooth muscle cells. Additionally, deposits of dystrophic calcification are evident. (e-h) Masson's trichrome stain reveals extensive accumulations of collagen fibers within the intima layer and in the vicinity of dystrophic calcifications. (i-l) Weigert stain illustrates the presence of elastic fibers within the intima layer and in the region where the internal elastic lamina appears to be disrupted by dystrophic calcification. (m-p) Von Kossa stain highlights calcium deposits within the intima layer.
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case_images: fig3
case_images: Weigert for elastic fibers, and Von Kossa silver nitrate for calcium deposits, were employed to characterize the lesion morphologically. Masson's trichrome stain showed extensive areas of fibrosis in the intima layer (Figure 3(e-h)). Weigert stain showed several elastic fibers in the intima and the inner elastic fiber almost entirely preserved, except in some regions where calcified deposits provoked this disruption (Figure 3(i-l)). Finally, the Von Kossa stain confirmed calcium-associated deposits in the tunica intima and a few in the tunica media (Figure 3(m-p)).
case_images: Multislice computed tomography examination of the patient showing no signs of the disease after lesion removal and the absence of other atherosclerotic changes in the head and neck. (a) Axial section of the upper jaw. (b) Soft tissue window of the axial section of the upper jaw. (c) Coronal section. (d) Three-dimensional reconstruction.
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case_images: fig4
case_images: The CT scan did not detect alterations in other facial artery branches (Figure 4).
case_images: PMC11828654_02