PMC4339865_01
(a) A picture of the patient at initial presentation to our clinic July 2014. A right-sided mass is evident causing trismus and other related mass effect symptoms. The lesion measured 7.1 cm at greatest dimension. (b) A picture of the patient at a 3-month follow-up appointment. Tumor regression as well as accompanying symptomatic relief is apparent when comparing to prior image (a). Lesion measured 4.9 cm at greatest dimension.
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A few months after her second surgery the mass had rapidly grown in size filling her mouth and causing right facial swelling (Figure 1(a)). She recently completed four cycles of this regimen and a follow-up CT demonstrated overall tumor regression to a measurement of 4.9 cm at its greatest dimension as compared to 7.1 cm at initial presentation (Figures 1(b) and 2(c)).
(a) A computed tomographic scan of the maxillofacial region with contrast showing the maxillary IMT in axial section at initial presentation July 2014. (b) A coronal section of the same CT scan highlighting extent of invasion. (c) A CT scan of the head without contract to rule out an intracranial hemorrhage October 2014. Image demonstrates tumor regression when compared with (a) and (b).
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CT scan of the neck showed an extensive destructive mass measuring 5.5 cm x 5.3 cm x 7.1 cm with extension into the medial wall of maxillary sinus and extending to the inferior orbit (Figures 2(a) and 2(b)).
Pathologic findings by hematoxylin and eosin staining of maxillary tumor tissue samples. (a) Whorled and fascicular spindle cells with moderate nuclear atypia and mitotic activity are heavily infiltrated by mixed chronic inflammatory infiltrate at 125x magnification. (b) Similar findings at 500x magnification.
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It was felt that pathology was consistent with inflammatory myofibroblastic tumor (Figures 3(a) and 3(b)).