PMC3716018_01
Diffuse swelling (arrow) is seen in the molar region on the right side of the face.
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F1
On clinical examination, the patient appeared dull and weak with mild facial asymmetry due to a diffuse facial swelling on the right side [Figure 1].
Well-circumscribed, ovoid swelling (arrow) is seen in the midline of the soft palate.
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F2
The swelling was roughly spherical in shape, with a color of the mucosa, smooth-surfaced, sessile, soft in consistency, and without any secondary changes like ulceration or discharge [Figure 2].
Postero-Anterior view of the skull radiograph shows diffuse opacification of the right maxillary antrum (yellow arrow).
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F3
No bony destruction was, however, observed [Figure 3].
Coronal section, contrast-enhanced computed tomography scan shows a large heterodense destructive soft tissue lesion with intense contrast enhancement on the right maxillary antrum (yellow arrow), crossing the midline and displacing the nasal septum to the left (red arrow) and superiorly into the nasal cavity (blue arrow).
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CT scan revealed a large heterodense destructive soft tissue lesion showing intense contrast enhancement [Figure 4]. (+25 +-35 HU pre-contrast and +60 +-120 HU post-contrast)
Axial section, contrast-enhanced computed tomography scan shows a large heterodense destructive soft tissue lesion seen in the superior postero-lateral wall of the right nasal cavity, extending into the nasopharynx and adjacent pterygopalatine fossa, right pre-maxillary space causing bowing of the posterior antral wall: The characteristic Holman Miller sign (yellow arrow) with erosion/ destruction of adjacent bones.
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F5
The tumor mass was seen in the superior postero-lateral wall of the right nasal cavity, extending into the nasopharynx and adjacent pterygopalatine fossa and the right pre-maxillary space causing bowing of the posterior antral wall with erosion/destruction of adjacent bones. The infra-temporal fossa, orbit, and middle cranial fossa on the right side were also encroached by the lesion [Figure 5].
Axial section, T1-weighted magnetic resonance image shows a large, well-defined mass (arrow) in the region of the pterygo-maxillary fissure and sphenopalatine foramen on the right side with a heterogenous intensity.
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Coronal section, T2-weighted magnetic resonance image demonstrates a large, well-defined hyperintense mass in the right maxillary antrum (red arrow), displacement of the nasal septum (blue arrow) by the heterointense tumor mass to the left side and tiny flow voids are noted within the lesion consistent with hypervascularity (yellow arrows)
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T2-weighted images [Figure 7]. Tiny flow voids were noted within the lesion consistent with hypervascularity [Figure 8]. The mass encroached into the masticator, buccal, and parapharyngeal spaces on the right side, right nasal cavity, right sphenoid sinus, floor of the middle cranial fossa, and the right cavernous sinus [Figure 9].
Axial section, T2-weighted magnetic resonance image reveals a large, well-defined mass in the region of the pterygo-maxillary fissure and spheno-palatine foramen on the right side with heterogenous intensity. Avid enhancement of the mass (red arrows) and tiny flow voids are noted within the lesion (yellow arrows) consistent with hypervascularity.
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F8
T2-weighted images [Figure 7]. Tiny flow voids were noted within the lesion consistent with hypervascularity [Figure 8]. The mass encroached into the masticator, buccal, and parapharyngeal spaces on the right side, right nasal cavity, right sphenoid sinus, floor of the middle cranial fossa, and the right cavernous sinus [Figure 9].
Sagittal section, T2-weighted magnetic resonance image shows a large, well-defined tumor mass (arrow) with a heterogenous intensity measuring 6.54 cm x 6.02 cm.
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F9
T2-weighted images [Figure 7]. Tiny flow voids were noted within the lesion consistent with hypervascularity [Figure 8]. The mass encroached into the masticator, buccal, and parapharyngeal spaces on the right side, right nasal cavity, right sphenoid sinus, floor of the middle cranial fossa, and the right cavernous sinus [Figure 9].
Right external carotid artery angiogram reveals the feeding internal maxillary artery (red arrow) and the hypervascular lesion (yellow arrows).
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