PMC3943513_01
Clinical and radiographic features. (A) Intraoral appearance of the neoplasm at first consultation. (B, C, D) Panoramic, occlusal and periapical radiographs revealed a radiolucent lesion extending from the upper right first molar to the upper left canine, with imprecise limits, suggesting involvement of the floor of the nasal cavity and ipsilateral maxillary sinus. Extensive bone resorption gave the appearance of floating teeth.
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F1
The initial differential diagnosis based on clinical findings included a benign neoplasm or an odontogenic cyst (Figure 1). Superiorly, it extended into the nasal cavity, with partial destruction of the nasal septum and inferior nasal turbinate (Figures 1B-D and 2).
Tomographic characteristics. Axial scans (A1, B1) and coronal reformatted images (C1, D1) in bone window, and the same axial (A2, B2) and coronal (C2, D2) slice levels in contrast-enhanced soft tissue window. (A, B) The views show that the right inferior nasal concha was moderately increased in volume and tissue proliferation was observed in its anterior portion. (C, D) The nasal septum was partially destroyed. The lesion had invaded the alveolar process and soft tissue. Contrast enhancement was moderate and homogenous.
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F2
Superiorly, it extended into the nasal cavity, with partial destruction of the nasal septum and inferior nasal turbinate (Figures 1B-D and 2).
Histopathological and immunohistochemical findings. (A) Low-powered photomicrograph showing proliferation of islands and cords composed of small cells displaying either basaloid or fusiform morphology, a thick collagenized cellularized stroma with little inflammatory infiltrate. (B) In detail, neoplastic cells with pleomorphic and hyperchromatic nuclei. The cells in the tumour islands and cords were strongly positive for enolase (NSE), synaptophysin (SYN) and vimentin (VIM3B4). Some positive expression was also observed in the stromal cells. (Haematoxylin-eosin, original magnification x20[A], x100[B]; Immunohistochemical staining, original magnifications x40).
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F3
Prominent nucleoli, rosettes of the Homer Wright type (pseudorosettes) or true rosettes were infrequent, featuring Grade III according to Hyams' histopathologic grading system (Figure 3). Immunohistochemical staining was negative for neuroblastoma marker at 1:400 (clone NB84a, DAKO) (Figure 3).