PMC3800372_01
(a and b) Clinical photograph at presentation. (c, axial) and (d, coronal): CT scan showing a large destructive soft tissue lesion in the left maxillary sinus with extensions into the left nasal cavity, ethmoid and sphenoid sinus, left alveolus and hard palate. Extensions were also noted into the temporal fossa, soft tissues of the cheek, masticator spaces and inferior orbit
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F1
On intra-oral examination, a proliferative growth was noted in the left maxillary gingivo-buccal sulcus extending downwards till the level of the oral commissure [Figure 1a and b]. Extensions were also noted into the infra temporal fossa, soft tissues of the cheek, masticator spaces, and the inferior orbital fissure [Figure 1c and d].
(a and c) Light microscopy showed the presence of bits of fibrocollagenous tissue infiltrated by small round cells with scanty cytoplasm and hyperchromatic nuclei. At places the cells were arranged in rosettoid manner. Mitotic activity was not well made out. (b) Tumor cells showing immunopositivity to keratin (IHC, x100). (d) 50% of tumor cells showing nuclear positivity to Ki-67 (IHC, x100)
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F2
Transcription Factor-1 (TTF1). The tumor cells that showed strong nuclear positivity to Ki 67 was 50%. The final histopathology on immunohistochemistry correlation [Figures 2a-d and 3a-d] favored a diagnosis of SNEC.
(a) Tumor cells showing immunopositivity to CD 57 (IHC, x100). (b) Tumor cells showing immunopositivity to chromogranin (IHC, x100). (c) Tumor cells showing immunopositivity to synaptophysin (IHC, x100). (d) Tumor cells showing immunopositivity to NSE (IHC, x100)
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F3
Transcription Factor-1 (TTF1). The tumor cells that showed strong nuclear positivity to Ki 67 was 50%. The final histopathology on immunohistochemistry correlation [Figures 2a-d and 3a-d] favored a diagnosis of SNEC.
(a and b) Clinical photograph post-chemoradiation. (c and d) A post-therapy CT scan (after 6 months) showing only residual thickening of the left maxillary antrum
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F4
The patient did not wish to undergo any further investigations/biopsy to confirm remission; she is being followed up with a combination of clinical examination and imaging and is presently symptom-free with no evidence of recurrence for close to 2 years now [Figures 4a and b].