History:
This 33-year-old woman had suffered from long-standing nasal obstruction. Examination
revealed a large polyp in the right nasal cavity. At the time this was resected, the
surgeon noted that a mass involved the lateral wall. Subsequent investigation, including a
CT scan, revealed tumor involving the right maxillary, ethmoid and sphenoid sinuses. A
full course of radiation was followed by right lateral rhinotomy, right medial
maxillectomy, and right ethmoidectomy and sphenoidectomy.
Histology:
The resected specimen consisted of polypoid, gray-white, lobulated tissue (4.0x2.8x2.0
cm). Deep to the residual respiratory epithelium covering the polyp was an infiltrating,
cellular, vascularized tumor (Fig. 1). Angular, closely associated tumor cells with
pleomorphic and hyperchromatic nuclei with frequent mitotic figures formed the tumor (Fig.
2). As in this region, some tumor cells were arranged in interconnecting narrow cords with
some focal, round to oval intercellular spaces. Other areas had a more solid growth
pattern.
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| Figure 1: Cellular tumor infiltrating below the respiratory epithelium of the polyp. | Figure 2: Small angular tumor cells form irregular cords within which are variably sized somewhat clear intercellular spaces. |
Differential diagnosis included olfactory neuroblastoma, poorly differentiated adenocarcinoma, and small cell carcinoma. Immunostains ordered on this basis showed that NSE, chromogranin, synaptophysin, CEA, EMA, vimentin and CD-34 were all negative. Only cytokeratin antibody AE1/AE3 was focally positive (1 to 2+) (Fig. 3).
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| Figure 3: Immunostain for cytokeratins (AE1/AE3). Focally some tumor cells are positive. |
Electron microscopy was done as part of this investigation.
Electron Microscopy
