Under local anesthesia, an excisional biopsy was performed. The specimen was removed in one piece (Figure 2).

Figure 2 This photograph is of the gross specimen removed in one piece.

Excisional Biopsy

Histologic examination reveals a multisected piece of soft tissue embedded in five separate blocks labeled A1-A5. All specimens are composed of soft tissue covered by epithelium and supported by a large mass of granulation tissue (Figures 3-5). The surface epithelium shows evidence of ulceration covered by fibrin and neutrophils (Figure 3). The granulation tissue comprises the bulk of the specimen and is loose and vascular and is intensely infiltrated by neutrophils, lymphocytes and plasma cells (Figures 4-5). It contains many blood vessels and shows evidence of endothelial and fibroblast proliferation. Some of the blood vessels are highly dilated and some are very small.

Figure 3 Low power (x40) the H & E histology reveals a large mass of ulcerated granulation tissue composed of proliferating fibroblasts, proliferating endothelial cells and small blood vessels of variable shapes and sizes.

Figure 4 Higher power (x100) the H & E histology reveals an ulcerated and vascular granulation tissue infiltrative by acute and chronic inflammatory cells.

Figure 5 Higher power (x200) the H & E histology of an ulcerated granulation tissue infiltrated by acute and chronic inflammatory cells.