Difficulties in diagnosing angiomatoid fibrous histiocytoma of the head and neck region: A case report

Figure 1 Computed tomography. A: Focal change on the right side of the submandibular space initially diagnosed as a venous malformation; B: Visible irregular outline of a moderately hyperintense area of 18 mm × 25 mm × 13 mm.

Figure 2 Fine needle aspiration at high magnification (400 ×, hematoxylin and eosin staining). A: Single bland cell with oval nucleus, smooth nuclear membranes, and conspicuous nucleolus; B: Spindle bland cells within an eosinophilic background.

Figure 3 A smooth contoured 3 mm defect in the cortical layer of the inner mandible on the right side near the border of the scan.

Figure 4 Histopathological diagnosis. A: Diffuse expression of smooth muscle actin. Excision, magnification 400 ×; B: Excision (400 ×, hematoxylin and eosin staining). Short spindled myoid and ovoid, histiocyte-like cells within a somewhat myxoid background.

Figure 5 Intraoperative picture. A: Intraoperative picture of submandibular, angiomatoid fibrous histiocytoma, tumor is marked with an arrow; B: Intraoperative picture of a destroyed external layer of the mandible, it is marked with an arrow; C: Intraoperative view of the second procedure, no AFH irregularities were found. Tissue scar are marked with arrows.

Figure 6 Magnetic resonance imaging before second surgical procedure. Just below the outline of the body of the mandible, a lesion suspected of a residual tumor mass of 4 mm × 8 mm × 4 mm is visible.

Figure 7 Proposed diagnostic and therapeutic path. AFH: Angiomatoid fibrous histiocytoma; CT: Computed tomography MRI: Magnetic resonance imaging.