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<p class="ql-align-justify">The sections show a highly cellular, infiltrative mesenchymal proliferation underlying a stratified squamous epithelial surface. The lesion is composed of bundles and fascicles of spindle-shaped cells and epithelioid cells with eosinophilic cytoplasm. Some cells exhibit elongated, "strap-like" appearances with eccentric nuclei, and there are areas suggesting primitive rhabdomyoblastic differentiation (cells with abundant pink cytoplasm). The stroma appears variably myxoid to collagenous with a prominent vascular pattern. While the surface epithelium appears intact in some areas, the dense cellularity and infiltrative growth pattern in a pediatric patient are highly concerning for a malignant small blue round cell tumor or a spindle cell sarcoma.</p><p class="ql-align-justify">Differential diagnosis includes Embryonal Rhabdomyosarcoma (specifically the spindle cell variant), Infantile Fibrosarcoma, or a Spindle Cell Tumour with NTPK fusion. Immunohistochemical studies are recommended (Desmin, Myogenin, CD34, S100, ALK, and Ki-67).</p>
<p class="ql-align-justify">Painless 2 cm x 2 cm oval-shaped swelling with lipid content located on the middle dorsal tongue, extending laterally and deep to the ventral surface, with no palpable lymph nodes.</p>
<p class="ql-align-justify">Soft tissue fragments collectively measured 1.3x1x0.5 cm, totally embedded.</p>
<p><strong><em><u>Middle dorsal tongue mass, incision biopsy:</u></em></strong></p><ul><li class="ql-align-justify"><strong>Atypical spindle cell proliferation suspicious for spindle cell rhabdomyosarcoma. </strong></li><li class="ql-align-justify"><strong>Recommended for confirmatory immunohistochemical studies. </strong></li></ul>
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