Treatment

Under local anesthesia, an incisional biopsy was performed and the results lead to the patient being referred to Otolaryngology for further evaluation. Under general anesthesia, the patient under went right total maxillectomy and right orbital floor and infraorbital reconstruction. He also underwent a right dacryocystorhinostomy, a split-thickness skin graft from the right thigh to the right cheek, and placement of a palatal prosthesis. The tumor measured 5.8 cm in extent and involved the maxilla and extended into the surrounding soft tissues, maxillary sinus, pterygoid plate and orbital floor.

Incisional Biopsy

The incisional biopsy and surgical specimens were diagnosed by Drs. Muehlenbachs, Morton, Schmidt and Hoch. The incisional and surgical specimen were made up of lobules of neoplastic cartilage that blend in with tumor bone (Figures 2 & 3) and all surrounded by high grade neoplastic spindles cells with hyperchromatic and angular nuclei (Figure 4).

Figure 2 Low power (x40) H & E histology illustrates fragments of hard and soft tissue with neoplastic bone and cartilage lobules partially surrounded by neoplastic spindle cells arranged in layers.

Figure 3 Higher power (x100) H & E histology with a closer look at the lobules of tumor bone and cartilage layered by neoplastic spindle cells.

Figure 4 Higher power (x200) H & E histology with a closer look at one of the lobules made up of tumor bone and cartilage surrounded by layers of neoplastic spindle cells.