A 65-year old male presented with a painless gradually enlarging swelling on the left side of the cheek of 3 months duration. He also reported nasal obstruction and regurgitation (Fig 1).  [fig 2, three weeks after initial presentation]

There was no history of high fever. His personal history revealed that he is a tobacoo (betel quid) user for the past 45 years [15 times/day]. His past medical history revealed that he underwent radiotherapy (30 gy/3#/1000 cgy per fraction) 7 years back for a malignant lesion (Plasmacytoma) in the tonsillar region with secondaries in the right neck. Except for this information, no other relevant past medical details was elicitable.

On examination, a well defined smooth surfaced swelling over the left maxillary region extending from the anterior border of the ramus to the left lateral wall of the nose, superiorly, it extends to the infraorbital margin. Nasal septum is deviated. Lymph node examination of the body failed to reveal palpable nodes. Abdominal examination failed to reveal palpable mass. On intra oral examination, a nodular growth was seen in the left maxillary alveolus extending from the left maxillary canine to the tuberosity. [medially, to midline raphe and laterally, to the left buccal sulcus].

Computed tomography (CT) showed evidence of soft tissue density lesion in the maxillary sinus involving the orbit, left nasal cavity, ethmodial sinus, sphenoidal sinus, cheek and intratemporal fossa. CT also revealed erosion of the left inferior orbital plaste, alveolar process of maxilla, medial orbital wall and lateral nasal wall (fig 3). Laboratory findings showed white blood cell count (total and differential) within normal limits, ESR-22mm/hr and Hemoglobin-10.0 gms%. Peripheral smear showed normocytic and hypochromic anemia.

The histological photomicrograph is taken from the most representative area of the sections (figures 4 through 12 ). Immunohistochemistry is not done yet. Interpretation of this case will be uploaded for further discussion shortly after the members rendered their morphological interpretation of this case.

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