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Pathology Quiz Case

Pathology Quiz Case A 64-year-old man presented with a 6-month history of recurrent left-sided epistaxis and nasal congestion. He did not smoke and had no history of allergic rhinitis, sinusitis, or coagulopathy. He denied pain, headache, or visual changes. Physical examination revealed a polypoid mass completely obtructing the left nasal cavity. The patient's pupils were symmetrically reactive, and there was no proptosis or extraocular muscle entrapment. The oral cavity was edentulous, and the palate was without lesions. A computed tomogram demonstrated a large, homogeneous mass filling the left nasal cavity as well as the ethmoid and maxillary sinuses (Figure 1). There was no evidence of orbital or intracranial extension; however, there was bony erosion at the floor of the maxillary sinus. An excisional biopsy, which was performed via an endoscopic medial maxillectomy approach, showed that the mass was arising from the inferior and lateral walls of the left maxillary sinus. Histopathologically, the lesion was submucosal, without any connection with overlying respiratory epithelium, and composed of numerous epithelial islands rimmed by basaloid cells (Figure 2). The islands were separated by loose, mature fibroconnective tissue. The central portion of almost all of the epithelial islands showed squamous differentiation. Peripherally, the cells showed palisaded layers of tall columnar cells with polarization of nuclei away from the basement membrane. No cytologic atypia, necrosis, or cystic changes were present in the central and peripheral zones of the epithelial nests or in the intervening stroma (Figure 3). Immunohistochemically, the tumor cells exhibited strong reactivity for keratin (AE1/AE3) but were negative for the proliferation marker Ki-67. Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. View LargeDownload What is your diagnosis? http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology–Head & Neck Surgery American Medical Association

Pathology Quiz Case

Abstract

A 64-year-old man presented with a 6-month history of recurrent left-sided epistaxis and nasal congestion. He did not smoke and had no history of allergic rhinitis, sinusitis, or coagulopathy. He denied pain, headache, or visual changes. Physical examination revealed a polypoid mass completely obtructing the left nasal cavity. The patient's pupils were symmetrically reactive, and there was no proptosis or extraocular muscle entrapment. The oral cavity was edentulous, and the palate was...
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Publisher
American Medical Association
Copyright
Copyright © 2007 American Medical Association. All Rights Reserved.
ISSN
0886-4470
DOI
10.1001/archotol.133.11.1167
pmid
18025326
Publisher site
See Article on Publisher Site

Abstract

A 64-year-old man presented with a 6-month history of recurrent left-sided epistaxis and nasal congestion. He did not smoke and had no history of allergic rhinitis, sinusitis, or coagulopathy. He denied pain, headache, or visual changes. Physical examination revealed a polypoid mass completely obtructing the left nasal cavity. The patient's pupils were symmetrically reactive, and there was no proptosis or extraocular muscle entrapment. The oral cavity was edentulous, and the palate was without lesions. A computed tomogram demonstrated a large, homogeneous mass filling the left nasal cavity as well as the ethmoid and maxillary sinuses (Figure 1). There was no evidence of orbital or intracranial extension; however, there was bony erosion at the floor of the maxillary sinus. An excisional biopsy, which was performed via an endoscopic medial maxillectomy approach, showed that the mass was arising from the inferior and lateral walls of the left maxillary sinus. Histopathologically, the lesion was submucosal, without any connection with overlying respiratory epithelium, and composed of numerous epithelial islands rimmed by basaloid cells (Figure 2). The islands were separated by loose, mature fibroconnective tissue. The central portion of almost all of the epithelial islands showed squamous differentiation. Peripherally, the cells showed palisaded layers of tall columnar cells with polarization of nuclei away from the basement membrane. No cytologic atypia, necrosis, or cystic changes were present in the central and peripheral zones of the epithelial nests or in the intervening stroma (Figure 3). Immunohistochemically, the tumor cells exhibited strong reactivity for keratin (AE1/AE3) but were negative for the proliferation marker Ki-67. Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. View LargeDownload What is your diagnosis?

Journal

Archives of Otolaryngology–Head & Neck SurgeryAmerican Medical Association

Published: Nov 1, 2007

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