PMC4436330_01
Photomicrographs (of primary lesion) show islands and sheets of polygonal epithelial cell with prominent nuclei and eosiniphilic cytoplasm. Also, extensive amyloid deposition is remarkable. (H&E staining; X100) (a); (X400) (b)"
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F1
Histopathological examination of the excised lesion revealed a Pindborg tumor (Figure 1).
Axial (a) and coronal (b) computed tomography scan sections showing extension of the tumor to the left maxillary sinus and destruction of adjacent tissues.
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F2
On computed tomography scan, a massive intraosseous lesion was disclosed in the left maxilla involving the orbit and ethmoidal air cells superiorly and the nasal airway medially (Figure 2).
Microscopic evaluation shows nests and strands of large polyhedral epithelial cells with mild nuclear pleomorphism. Also, variable sized sheets of amyloid and small irregular foci of calcification are observed. (H&E staining; X100) (a, b); (X400) (c, d)
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F3
Incisional biopsy and histopathological examination verified the clinical diagnosis of CEOT (Pindborg tumor), which confirmed the recurrence of the previous tumor (Figure 3).
Photograph shows lateral rhinotomy incision connecting to the lower eyelid and lip split incision (a). Gross specimen of left hemimaxillectomy measuring 50x40x33 mm (b). Facial reconstruction was performed using a prefabricated, acrylic obturator (c). Post-operative photograph of the patient (d).
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F4
Surgical access to the tumor was gained through a lateral rhinotomy incision connecting to lower eyelid and lip split incisions (Weber Fergusson's approach) (Figure 4a). After complete excision of the entire tumor associated with partial ethmoidectomy (Figure 4b), a prefabricated acrylic obturator was inserted into the surgical defect for postoperative esthetics and to preserve function. This was secured in place using three 12 mm titanium mini-screws (Figure 4c). Orbital floor reconstruction was carried out using a titanium mesh plate (Figure 4d).
Three-dimensional CT scan revealed no recurrence in the follow up.
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F5
Recurrence was not detected until one year after the surgery (Figure 5).