Pathology Case Quiz 2

A N 86-YEAR-OLD WOMAN PRESENTED WITH a few months’ history of progressive fullness in the right side of her face along with localized discomfort in her right maxillary region. She denied any trauma, nasal obstruction, diplopia, neurologic deficits, dysphagia, odynophagia, voice changes, weight loss, cough, pulmonary symptoms, fever, or chills. She also denied any history of tobacco or alcohol use but did report a history of hypertension, narcolepsy, and previous orthopedic procedures. The results of her clinical examination were remarkable for bone loss in the region of the anterior hard palate and the bilateral premaxilla. However, no masses or mucosal lesions were detected during the rest of the head and neck examination. Facial computed tomography revealed a contrast-enhancing soft-tissue mass involving the right anterior paramedian maxilla and the anterior maxillary alveolar ridge, with evidence of bone destruction of the adjacent maxilla and invasion into the right nasal passage and the right maxillary sinus (Figure 1 and Figure 2). Hematoxylineosin staining of incisional biopsy specimens, which were obtained through a sinusotomy, demonstrated sheets of small blue cells (Figure 3). Further staining with CD20 revealed immunoreactivity only among a subpopulation of cells within the samples. Many nonstained small blue cells were also evident in the samples (Figure 4). Other immunohistochemical stainswerepositive forCD79a,CD3, and CD45RO. The specimen was negative for EpsteinBarr virus on in situ hybridization. What is your diagnosis?