Leimyosarcoma of the buccal mucosa and review of literature
A 35-year-old female presented with difficulty in opening the mouth since past 1 month. On clinical examination an ulcerative lesion on the left buccal mucosa adjacent to the maxillary left third molar was observed. The lesion was non-tender and firm in consistency, measuring about 1 × 1 cm in dimension, with inflamed surrounding margins. Lymph nodes were not palpable in the cervical region. An axial computed tomography scan showed an iso-dense mass in the right buccal mucosal region causing the swelling []. Excisional biopsy was done under local anesthesia, and the formalin fixed specimen was processed for histopathological examination. Microscopic examination revealed spindle shaped cells proliferating in various patterns []. The cells showed cellular and nuclear pleomorphism, increased mitotic figures, and prominent nucleoli. Single and multinucleated giant cells containing dark eosinophilic cytoplasm in a myxomatous connective tissue were also observed. Inflammatory cells and hyalinized blood vessels with spindle cells proliferation around them were evident. Immunohistochemical staining showed strong positivity for vimentin [], smooth muscle actin (SMA) [], and high proliferative index displayed by Ki-67 []. Desmin, S-100, and pancytokeratin were negative. These immunohistochemical findings satisfy the criteria for leiomyosarcoma. Due to loss of follow-up further treatment of the patient could not be completed.