PMC4916740_01
Coronal plane magnetic resonance imaging of the face shows a large tumor that fills the left maxillary sinus and invades the nasal cavity, face, and orbit, displacing the left globe
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F1
A magnetic resonance imaging (MRI) of the face and neck was performed and demonstrated an 8 cm solid mass centered in the left maxillary sinus with extension to the orbit, nose, left ethmoid sinus, and left pterygopalatine fossa [Figure 1].
Fine needle aspiration smears of the maxillary sinus mass showing (a) cellular specimen consists of numerous cells arranging singly and in small clusters (Papanicolaou, x10). (b) The malignant cells are round-to-oval and exhibit eccentrically located nuclei with fine chromatin and nucleoli (Papanicolaou, x40)
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F2
The nuclei showed fine chromatin and some with nucleoli and mild nuclear pleomorphism [Figure 2].
Tissue biopsy of the maxillary sinus mass showing sheets of plasmacytoid malignant cells with thick fibrous intervening myxoid stroma (H and E, x20)
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F3
Although the cells were uniform, cytologic atypia, frequent mitotic activity, and areas of necrosis were identified [Figure 3].
Pleural fluid smears showing (a) numerous malignant cells arranging singly and in small aggregates (Papanicolaou, x4). (b) The malignant cells exhibit eccentrically located nuclei with fine chromatin and nucleoli (Papanicolaou, x40) and (c) (Diff-Quick, x20)
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F4
Many single cells and naked nuclei were noted in the background [Figure 4a]. These cells were plasmacytoid in appearance and exhibited round-to-oval nuclei with slight nuclear membrane irregularity and nucleoli noted in the majority of cells [Figure 4b, c].
Cell block tissue section showing (a) clusters of malignant cells (H and E, x20), (b) positive for p63, and (c) pancytokeratin (AE1/AE3)
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F5
TTF1 [Figure 5]. The morphologic and immunohistochemical profile was similar to the original maxillary mass pathology, and a diagnosis of metastatic MECAs was rendered.