Recurrent extensive plasmacytoid myoepithelioma of the sinonasal cavity
The patient was a 57-year-old Iranian male living in Dargaz, a small district in north east of Iran. He was admitted to the E.N.T ward, Ghaem Hospital, Mashhad University of Medical Sciences in June 2010. He presented with a 17-year history of recurrent and resistant to treat sinonasal mass. First, at 1993, he accidentally discovered a small painless mass of the palate, which was excised in an outpatient care facility. After 4 years, the lesion recurred and the patient underwent medial maxillectomy. Thereafter, the patient had five more debulking surgeries.\nAt the time of admission, the patient was complaining of nasal fullness, hyponasal speech, snoring, oral breathing, and loss of hearing on left side.\nOn oral examination, the hard palate in the right side had been removed and a nasal mass was obvious through it. Uvula was in the midline. Both nasal cavities were completely filled with the mass. There was no cervical lymphadenophaty. The right tympanic membrane was retracted and the Weber test was shifted to right. All other physical examinations were unremarkable.\nLaboratory tests were within normal limits. Family and past medical histories were unremarkable and the patient was non-smoker.\nBoth computed tomography scan and magnetic resonance imaging demonstrated a huge bilateral lobulated sinonasal mass with extension to cribriform plate and near the dura, medial walls of both orbits, and upper gingival area []. The plain chest x-ray was normal.\nThe patient underwent a functional endoscopic sinus surgery to debulk the tumor. The removed specimen was stored in 10% buffer formalin and sent to the Pathology Department. The specimen was made by multifragmented irregular-shaped brownish soft tissue with the dimensions of 3.5 × 3 × 2 cm. The whole tissue was processed, cut, and stained with H and E. Microscopically, the specimen showed a hypercellular tumoral tissue composed of plasmacytoid cells with eccentrally located round-ovoid nuclei and acidophilic cytoplasms. The neoplastic cells were arranged in nests, cords, and sheaths intermixed with partially mucoid and hyalinized collagenous stroma. Scattered gland-like structures bordered by neoplastic cells were seen constituting less than 5% of the tissue. No atypia, mitotic activity, necrosis, and vascular- neural invasion were seen. Dispersed foci of spindle cells were also present surrounded by plasmacytoid cells []. A diagnosis of plasmacytoid myoepithelioma was made.\nOn immunohistochemistry staining, the specimen showed strong and diffuse reactivity for Vimentin, cytokeratin, smooth muscle actin and S-100 confirming the myoepithelial nature of the tumoral cells [].\nThe patient refused to undertake any more treatments. After 15 months of follow-up, the lesion did not progress further.