PMC7231817_01
Clinical extraoral photograph at the beginning of treatment and Pre-treatment multislice computed tomography. In 1A is observed facial asymmetry. In 1B is observed in the maxilla region between the zygomatic arch and the left labial commissure the extent of the tumor that promotes dystopia and nasolabial fold deletion with right nose displacement. In 1C and 1D is observed a large expansive hypodense image involving the middle third of the face.
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The extraoral clinical examination of the maxilla revealed a hardened and symptomatic tumour located between the zygomatic arch and the labial commissure, dystopia and depletion of the nasolabial fold with the displacement of the right nostril (Fig. 1A and B), while no palpable lymph nodes were observed. The lesion was poorly circumscribed, which is suggestive of a malignant neoplasm with extensive bone destruction and involvement of structures near the base of the skull such as the ethmoid and sphenoid bones (Fig. 1C and D).
A-F. Histopathology features of the sinonasal carcinosarcoma in the incisional biopsy specimen showing proliferation of cuboid cells with nuclear and cytoplasmic pleomorphism. It was also possible to observe the appearance of the tumour from the respiratory epithelial tissue (stained with HE). Scale bars: A, 200 mum and B, 20 mum.
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The tumour was also observed in the respiratory epithelial tissue with the presence of keratin beads, in situ focal carcinoma, necrotic areas and scarce stroma, bleeding and myiasis (Fig. 2).
Immunohistochemical picture. Revealing diffuse positivity for vimentin and chromogranine. There was focal marking of AE1/AE3, cytokeratin 14, EMA and CD99. The neoplastic cells were negative for S-100, calponin, smooth muscle actin, HHF-35, desmin, cytokeratin 7 and HMB-45. About 80% of neoplastic cells were positive for Ki-67.
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The neoplastic cells were negative for S-100, calponin, smooth muscle actin, HHF-35, desmin, cytokeratin 7 and HMB-45; while almost 80% were positive for Ki-67 (Fig. 3).
Surgical procedure. 5A, left maxillectomy. 5B, reconstruction of the orbit floor in titanium mesh.
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After the removal of a 11 x 6 x 4 cm single piece and curettage of the cavity, the orbital floor was reconstructed with titanium mesh (Fig. 4).
Control 30 days after the surgical procedure. 5A, Facial view. 5B, intra-oral view.
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