A 41-year-old patient with the only history of hepatitis A in childhood and no other medical diameter symptoms associated with a left premaxillary tumor, soft, mobile and not adhered to deep planes 4 showed slow growth.
At a simple view, cystic lesion or stenosis is impressive, but in the exploration its location and soft, elastic and mobile consistency make us suspect that it may be another type of lesion.
1.
The patient provides nuclear magnetic resonance (NMR) performed in another center, with a report of a 25 mm nodule in subcutaneous cellular tissue that does not affect the jaw bone and of nonspecific nature, to rule out the possibility of a non-specific facial tumor or hematoma.
the diagnosis is compatible with the vascular pattern we programmed the patient to perform a biopsy in the operating room under local anesthesia, during which we found a great friability and bleeding in the sheet of the tumor that impresses a lesion of vascular nature
The immunohistochemical study of the biopsy showed the following results: positive for CD99 (diffuse), BCL2, Betacatenin (intracytoplasmic, T100), and CD341, AELUT (cytoplasmic factor-1, negative).
The Ki 67 cell proliferation index is 5%.
After confirming the diagnosis and having performed the initial MRI in another center, the Radiology Service of our hospital recommends us to perform an additional imaging study with computerized axial tomography (CAT) to rule out with greater certainty the presence of a subcutaneous lesion.
1.
Under this final diagnosis, we surgically intervened under general anesthesia using magnifying view with magnifying glasses (x4.3); we removed the en bloc tumor with a margin of safety of approximately 2.5 cm, including the inferior orbital muscle involved:
We expose the entire angular branch of the facial artery, which is inserted into the sinus of the tumor and which we ligate, as well as the facial nerve branches remaining in the surgical bed
1.
Surgical defect was reconstructed with a cheek advancement flap of inferolateral base.
1.
The postoperative course was favorable and the patient was discharged two days after surgery without complications.
The final pathological report of the specimen was hemangiopericytoma that respects the surgical margins of resection, with accompanying giant cell inflammation of the foreign body.
The definitive immunohistochemical study of the resection specimen was positive for diffuse CD34, focal CD99, and negative for S-100, CD31 and factor VIII, with a Ki-67 cell proliferation index of 5%.
1.
We present the case in the hospital's tumor committee, where based on the postoperative results, it was decided that no treatment was necessary, only a periodic follow-up of the patient.
Two years after surgery, the patient has a favorable evolution, with good aesthetic and functional results, and no data of recurrence or clinical or radiological in postoperative controls performed to date.
