case_images: PMC6415291_01
case_images: From left to right: (a) exhibits patient facial aspect at the first consultation, note the slight bulging in the left side of the face; (b) demonstrates the lesion fast progress by showing the evident lesion growth in 3 weeks; (c) shows lesion shrink after 4 weeks of chemotherapy.
case_images: CRID2019-6701783.001.jpg
case_images: PMC6415291_01_CRID2019-6701783.001.jpg
case_images: fig1
case_images: Extraoral examination showed no lymphadenopathy or paresthesia but an evident swelling in the left cheek (Figure 1(a)) with a hardened consistency. Despite of accomplishing imaging examinations as requested in the first consultation, the patient only came back to the Oral and Maxillofacial service after three weeks, when she felt paresthesia and severe pain in her left face.  Figure 1(b) exhibits the patient left face swelling aspect at this moment.
case_images: First consultation examination. (a) The axial MCT scan shows a soft-tissue mass anterior to the maxillary sinus, left side, and sinus anterior and lateral wall bone erosion. (b) Coronal MCT scan exhibits nasal cavity involvement by soft-tissue mass, as well as sinus lateral wall bone destruction.
case_images: CRID2019-6701783.002.jpg
case_images: PMC6415291_01_CRID2019-6701783.002.jpg
case_images: fig2
case_images: The first consultation MCT axial slices revealed a soft tissue hypodense area in the left side, comprising the maxillary sinus area and bone discontinuity in the anterior and lateral maxillary sinus wall (Figure 2(a)) orbital cavity floor. Frontal slices showed discrete nasal cavity involvement (Figure 2(b)).
case_images: Histopathological features: in (a), the histologic section from the lesion biopsy sample shows a diffuse and permeative infiltrate of small to medium-sized atypical lymphocytes (H&E, x100); in (b), an evident angiocentric and angiodestructive growth pattern is represented (H&E, x400). Immunohistochemical and in situ hybridization reactions: in (c), the neoplastic cells show immunopositivity for CD45 (x400); in (d), immunopositivity (partial/weak) for CD3 (x400); in (e), immunonegativity for CD20 (x400); in (f), immunopositivity for CD56 (x400); in (g), immunopositivity (cytoplasmic granules) for TIA1 (x400); in (h), Ki67 index (x400); and in (i), positive nuclear labeling for in situ hybridization for EBV (x400).
case_images: CRID2019-6701783.004.jpg
case_images: PMC6415291_01_CRID2019-6701783.004.jpg
case_images: fig4
case_images: Mild epithelium tropism and espongiosis were observed (Figures 4(a) and 4(b)). Trial immunohistochemical and in situ hybridization reactions were made (Figures 4(c)-4(i)).