A 65-year-old male patient reported with a chief complaint of ulcer in the right lower back tooth region of 31/2 months duration and gave a history of difficulty in mouth opening and swallowing. He had a history of bidi smoking 12/day for a period of 50 years and also gave the history of tuberculosis which was treated last year.
Intraorally, an ulceroproliferative growth was present in the right posterior mandibular region distal to molar which was nontender, well defined with irregular surface showing white projection [Figure 1a]. On examination, right submandibular lymph node was palpable. On radiographic examination, orthopantomograph (OPG) showed slight erosion of the underlying bone in the right posterior mandibular region [Figure 2a].
On the basis of clinical and radiographic features, a provisional diagnosis of tuberculous ulcer was given.
An incisional biopsy was done and sent for histopathological examination, which showed top to bottom features of dysplasia such as altered nuclear-cytoplasmic ratio, pleomorphism, hyperchromatism and few aberrant mitotic figures in the overlying epithelium without any invasion into the underlying stroma. Hence, the diagnosis of carcinoma in situ was given [Figure 3].
Then, the complete excision of the lesion was done, and hematoxylin and eosin-stained sections revealed overlying parakeratinized dysplastic stratified squamous epithelium invading the underlying connective tissue. The underlying connective tissue stroma comprised of numerous nests, cords and gland-like lobules of closely packed pleomorphic, hyperchromatic basaloid cells with nuclear palisading. The periphery of the neoplastic nests is surrounded by a fibrous stroma with prominent areas of comedo necrosis [Figure 4]. Few islands showed squamous cells surrounded by basaloid cells. Keratin pearls, increased and abnormal mitotic figures within squamous islands were evident [Figure 5]. The mixed composition of basaloid and squamous cells was striking. Surrounding stroma showed chronic inflammatory cells and blood vessels. Based on histopathological report, the diagnosis of BSCC of retromolar area was given.