Oral Oncology EXTRA (2006) 42, 157– 159

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CASE REPORT

A case of maxillary sinus carcinoma

Bruno Correia Jham *, Ricardo Alves Mesquita,
Maria Cássia Ferreira Aguiar, Maria Auxiliadora Vieira do Carmo

Department of Oral Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av Antonio Carlos,
6627 Pampulha, 31270-901 Belo Horizonte, Minas Gerais, Brazil

Received 28 October 2005; accepted 29 October 2005

KEYWORDS Summary Malignant tumors of the nasal cavity and paranasal sinuses are rare, with poorly dif-
Maxillary sinus ferentiated squamous cell carcinoma of the maxillary sinus being the most common. The aim of
carcinoma; this study is to report a carcinoma affecting the maxillary sinus of a young adult, with diagnosis
Paranasal sinus only being achieved with an intra-oral biopsy, after the lesion had perforated the palate bone.
carcinoma; This case stresses the importance of early diagnosis of maxillary sinus carcinoma, in order to
Malignant neoplasm increase chances of survival.
c 2005 Elsevier Ltd. All rights reserved.

Introduction The aim of this study is to report a carcinoma affecting

Malignant tumors of the nasal cavity and paranasal sinuses
are rare, comprising less than 1% of all malignancies, with
poorly differentiated squamous cell carcinoma of the max-
illary sinus being the most common.1,2
This disease mainly affects men in their sixth or seventh
decade of life.3 Most lesions remain asymptomatic or mimic
sinusitis for long periods while the tumor grows to fill the
sinus. Hence, diagnosis may not be made until the lesion
has perforated through the surrounding bone, and most
patients are diagnosed with advanced disease.2,4 While
optimal treatment patterns, including radiation therapy,
conservative surgery and chemotherapy are still under
debate, the prognosis remains poor.2
* Corresponding author. Tel.: +55 31 9182 8934; fax: +55 31 3499
2427.
E-mail address: brunocjham@yahoo.com.br (B.C. Jham).
the maxillary sinus of a young adult, with diagnosis only
being achieved with an intra-oral biopsy, after the lesion
had perforated the palate.
Case report
A 30-year-old black man sought care for evaluation of a
swelling that had appeared following extraction of the third
molar, one month before. The patient reported he was
under sinusitis treatment for the past 18 months and com-
plained of diplopia. During extra-oral examination, facial
asymmetry and a painful swelling were noted in the left
maxillary sinus region. Also, the contour of the left eyeball
was altered and the cervical and submandibular nodes were
palpable (Fig. 1A). Upon intra-oral examination, a 30-mm,
asymptomatic, dark-colored, exophytic, soft, tumoral mass
was observed in the left upper molar region extending into


1741-9409/$ - see front matter c 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ooe.2005.10.011
158
Figure 1 (A) Extra-oral clinical view showing facial asymme-
try and altered contour of the left eyeball. (B) Dark-colored,
exophytic, soft, tumoral mass was observed in the left upper
molar region extending into the palate observed upon intra-oral
examination. (C) Computerized tomography revealing destruc-
tion of the medial maxillary sinus wall, invasion of the nasal
cavity, destruction of the maxilla’s lateral wall with invasion of
the zygomatic bone, as well as destruction of the orbit floor and
(D) invasion of the nasal cavity, maxillary sinus and pterygo-
maxillary space soft tissues. (E) Bone scintillography revealed
absence of bone metastasis. (F) No clinical sign of residual oral
lesion on 12 months follow-up, however computerized tomog-
raphy showed that the lesion was even more invasive (G).
the palate (Fig. 1B). Computerized tomography revealed
destruction of the medial maxillary sinus wall, invasion of
the nasal cavity, destruction of the maxilla’s lateral wall
with invasion of the zygomatic bone, as well as destruction
of the orbit floor (Fig. 1C). In addition, invasion of the nasal
cavity, maxillary sinus and pterygomaxillary space soft tis-
sues could be seen (Fig. 1D). In view of the clinical and
imaginological findings, a maxillary sinus malignant neo-
plasm diagnosis was hypothesized. The patient was submit-
ted to an incisional biopsy, and the specimen was fixed in
formaldehyde at 10%. Histological examination revealed a
solid tumoral mass invading adjacent bone structures com-
posed by spindle and round epithelial cells presenting malig-
nant characteristics, i.e., cellular pleomorphism, nuclear
hyperchromatism and altered nucleus/cytoplasm ratio,
B.C. Jham et al.
Figure 2 (A) Spindle and round epithelial cells presenting
malignant characteristics (hematoxylin and eosin stain; ·400
magnification). (B) Immunopositive cells were observed only for
cytokeratins (streptavidine-biotine, ·400 magnification).
were also seen (Fig. 2A). Immunohistochemical analysis
was performed for actin, human epithelial membrane, cyto-
keratins, desmin, HMB-45 and S-100. Immunopositive cells
were observed only for cytokeratins, confirming the epithe-
lial origin of the lesion (Fig. 2B). Diagnosis of maxillary sinus
carcinoma was achieved, and the patient was referred to a
head and neck surgeon. Bone scintillography revealed that
the lesion was confined to primary site, with absence of
bone metastasis (Fig. 1E). The patient was submitted to
chemotherapy, followed by surgery and post-operative
radiotherapy. Twelve months later, slight facial asymmetry
and reduction of the eyeball alteration could still be ob-
served. There was no clinical sign of residual oral lesion
(Fig. 1F). However, a new computerized tomography
showed that the lesion was now even more invasive and con-
sidered to be unresectable (Fig. 1G). Chemotherapy was
again delivered, as a last treatment option. Unfortunately,
the patient deceased 15 months later.
Discussion
Malignant neoplasms arising from the paranasal sinuses are
rare, and even institutions with a referral practice for head
A case of maxillary sinus carcinoma
and neck cancer need many years to accumulate enough pa-
tients.5 This case presented clinical, imaginological, histo-
logical and immunohistochemical features of a maxillary
sinus carcinoma.
The disease has a predilection for males (male/female
ratio 2.3/1), with age range 38–89 years (mean 64 years).3
Patients usually are diagnosed with advanced disease, with
as much as 90% of the patients presenting T3/T4 stages.6
However, lymph regional metastases are not frequently
found, with incidence ranging from 3.3% to 26%.5 Our pa-
tient presented with the most common features of maxillary
sinus carcinoma, i.e., male with advanced disease misdiag-
nosed as sinusitis. In contrast, he was a young patient and in
addition showed regional metastasis. It has been noted that
the majority of patients are cigarette smokers, and many
work in mining, smelting or woodworking industries.3
Similarly, our patient reported smoking and he worked as
a painter, hence was frequently inhaling toxic components
of paint. Thus, we can hypothesize that this may have had
a role in his disease pathogenesis.
The most common symptoms are pain (59%), followed by
oral symptoms (40%), and facial swelling (38%). Nasal
obstruction (35%) and epistaxis (25%) may also be seen.3
Although our patient showed facial swelling and also com-
plained of pain, the precise diagnosis was not obtained until
an oral swelling had appeared following a tooth extraction.
Moreover, he was already being treated for nasal obstruc-
tion for nearly two years. Considering the median time from
onset of symptoms until diagnosis, which is about four
months,5 it took a long time for our patient to be diagnosed.
Indeed, it has been stated that diagnosis of sinus malignan-
cies is difficult to obtain, due to the air filled nature and
deep position of structures involved.7,8 Hence, our case
strongly emphasizes that misdiagnosis is crucially respon-
sible for diagnosis delay, and efforts should be made to
avoid it.
The optimum management of carcinoma arising in the
maxillary sinus remains undefined. Therapeutic approaches
include surgery, radiation and systemic and topical
chemotherapy in a variety of combinations and sequences.3
Maxillary sinus malignancies have a poor prognosis, with the
159
five-year cause-specific survival rate being 43% and overall
survival of 52 months.2,3,6 Advanced T stage, regional and
distant metastasis are highly predictive of poor prognosis.5
Our patient presented both advanced T stage and regional
metastasis, and survived for 28 months despite being sub-
mitted to chemotherapy, surgery and radiotherapy.
In conclusion, this case stressed the importance of early
diagnosis of maxillary sinus carcinoma, in order to increase
chances of survival and to reduce morbidity.
Acknowledgements
The authors would like to thank CAPES, FAPEMIG and CNPq
for financial support. R.A. Mesquita and M.C.F. Aguiar are
fellow researchers of CNPq.
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