Under local anesthesia, a small biopsy was taken. The results of the incisional biopsy were such that the patient was referred to an ENT surgeon for definitive treatment.

Incisional Biopsy

Histological examination of the H & E section revealed surface epithelium exhibiting atypical epithelial changes and invading the underlying fibrous and skeletal muscle fibers. The atypical epithelial changes are manifested in large cells with prominent nuclei, cellular and nuclear disorganization and pleomorphism, loss of maturation, high mitotic activity, individual cell keratinization and keration pearls. The neoplastic epithelial cells invade the connective tissue and muscle fibers in form of small islands, nests and cords of cells. The connective tissue is also infiltrated by lymphocytes, plasma cells and neutrophils.

Figure 2 Low power (x100) the H & E histology reveals neoplastic epithelial islands invading the underlying connective tissue and skeletal muscle bundles.

Figure 3 Low power (x200) the H & E histology of a slightly higher power shows the neoplastic epithelial cells invading the skeletal muscle bundles. The neoplastic cells show evidence of individual cell keratinization and a portion of a keratin pearl.

Figure 4 High power (x400) the H & E histology shows the neoplastic epithelial cells with high mitotic activity.