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Presented by Justin A. Bishop, M.D. and prepared by Sarah Karram, M.D.
Case 1: 70 year old woman with a maxillary sinus mass.
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Question 1 of 1
1. Question
Week 583: Case 1
70 year old woman with a maxillary sinus mass.images/Karram/case1_1.jpg
images/Karram/case1_2.jpg
images/Karram/case1_3.jpgCorrect
Answer: Metastasis
Histology: The tumor consists of a highly cellular proliferation of vaguely spindled epithelioid cells. It is frankly malignant, with perineural invasion, significant nuclar atypia, and brisk mitotic activity. No squamous or glandular differentiation is apparent at the histologic level. A cytokeratin stain (not pictured) was strongly positive.
Discussion: Whenever a neoplasm has an unconventional appearance for a given anatomic site, a metastasis (especially carcinoma or melanoma) should be considered. Often the clinical history is the most helpful. In this case the patient had a known history of lung cancer, and as a result, immunostains for TTF-1 and Napsin A (highly specific for lung adenocarcinoma) were performed and found to be positive.
Incorrect
Answer: Metastasis
Histology: The tumor consists of a highly cellular proliferation of vaguely spindled epithelioid cells. It is frankly malignant, with perineural invasion, significant nuclar atypia, and brisk mitotic activity. No squamous or glandular differentiation is apparent at the histologic level. A cytokeratin stain (not pictured) was strongly positive.
Discussion: Whenever a neoplasm has an unconventional appearance for a given anatomic site, a metastasis (especially carcinoma or melanoma) should be considered. Often the clinical history is the most helpful. In this case the patient had a known history of lung cancer, and as a result, immunostains for TTF-1 and Napsin A (highly specific for lung adenocarcinoma) were performed and found to be positive.
