Treatment

As noted above, incisional biopsy was performed under local anesthesia and the tissue was submitted for microscopic examination. The histopathological and immunohistochemical results led to transfer of the patient to another physician for further workup.

Excisional Biopsy

Histologic examination reveals multiple small pieces of soft tissue composed of fibrous and granulation tissue with small islands of epithelial cells (Figure 3). The fibrous tissue comprises the bulk of the specimen and surrounds small islands of epithelial cells. Some of these epithelial cells display very dark nuclei and alteration in the nuclear/cytoplasmic ratio while others show empty looking cytoplasm. The epithelial islands are present throughout the connective tissue. Also present are fragments of calcified bone with viable osteocytes. The Immunohistochemistry staining is positive with antibodies to PSA (Figure 4) and PAP (Figure 5).

Figure 3 Low power (x40) H & E histology illustrates fragments of hard and soft tissue with normal lamellar and reparative calcified bone and loose connective tissue containing small islands of epithelial cells, some cells with very dark nuclei demonstrating analteration in the nuclear/cytoplasmic ratio while others show empty looking cytoplasm.

Figure 4 Higher power (x200) Immunohistochemistry stain histology with a closer look at the small neoplastic epithelial islands staining positive with antibodies to PSA.

Figure 5 Higher power (x200) Immunohistochemistry stain with a closer look at the small neoplastic epithelial islands staining positive with antibodies PAP.