Head & Neck Case Review 2024-09

Head & Neck Case Review

September, 2024

History

A young adult presented with severe nasal congestion and was found to have a destructive 2.0 cm nasal cavity soft tissue mass by CT scan. The mass was biopsied, and microscopic examination revealed a malignant neoplasm composed of predominantly undifferentiated cells with a high nuclear-to-cytoplasmic ratio, a monotypic appearance, and abundant tumor necrosis. Immunohistochemically, tumor cells are strongly positive for AE1/AE3, p63, and the stain in Panel C of below figure.

Images

Quiz

1. The speckled nuclear pattern of staining in Panel C is a specific surrogate marker for a rearrangement involving which gene?

A. SMARCB1
B. EWSR1
C. NUTM1
D. IDH2

2. True or False: This is an extremely aggressive malignancy; however, some fusion partners have an overall better prognosis than others.

Contributors

Melad N. Dababneh, MBBS
Head and Neck Pathology Fellow
Cleveland Clinic

Vincent Cracolici, MD
Staff Pathologist
Cleveland Clinic

Head & Neck Case Review 2022-08

Head & Neck Case Review

August, 2022

History

A 36-year-old man presented with left eyelid drooping for one year along with progressively worsening headaches, blurry vision and diplopia for the prior month. A CT scan of the head showed a mass in the left maxillary sinus measuring 5.5 x 4.4 x 3.3 cm with bony destruction of the maxillary sinus walls and extension into the soft tissues of the posterior left orbit. The clinical and radiographic findings were highly suspicious for malignancy. A biopsy of the mass was subsequently performed. Representative CT scan radiographic images of the mass along with images of the surgical pathology are shown below.

Images

Quiz

1. To qualify as chronic invasive fungal rhinosinusitis (CIFR), symptoms must be present for at least:

  • A. 4 weeks
  • B. 8 weeks
  • C. 12 weeks
  • D. 26 weeks

2. Which of the following histopathologic features is seen in chronic granulomatous invasive fungal rhinosinusitis (CGIFR)?

  • A. Submucosal edema
  • B. Extensive fibrosis
  • C. Angioinvasive fungal hyphae
  • D. Well-formed granulomas with discrete rimming by mature lymphocytes
  • E. None of the above

Diagnosis

Contributors

George de Castro, BS, Medical Student
MD Program
Vanderbilt University School of Medicine

James Lewis Jr., MD
Department of Pathology, Microbiology, and Immunology
Vanderbilt University Medical Center