J Korean Assoc Oral Maxillofac Surg.  2018 Feb;44(1):29-33. 10.5125/jkaoms.2018.44.1.29.

Primary sinonasal mucosal melanoma simulated as cystic lesions: a case report

• Shin SH
• Seok H
• Kim SG
• Hong SD

• KMID: 2405374
• DOI: http://doi.org/10.5125/jkaoms.2018.44.1.29

Abstract

Sinonasal mucosal melanoma (SNMM) in the maxillary sinus is a rare disease condition. Compared to oral mucosal melanoma, SNMM has a bulky, exophytic, and polypoid appearance, is weakly pigmented, and associated with unspecific symptoms. Due to these features, SNMM in the maxillary sinus has been misdiagnosed as nasal polyps and chronic sinusitis. In this case report, we described SNMM occurring in the right maxillary sinus simulated as a cystic or benign lesion. Cortical bone thinning and expansion were observed around the mass. The excised soft mass was encapsulated and weakly pigmented. The mass was clearly excised and covered with a pedicled buccal fat pad graft. Diagnosis using immunohistochemistry with S-100 and homatropine methylbromide-45 (HMB-45) is critical for proper treatment.

Keyword

Sinonasal mucosal melanoma; Maxillary sinus; Buccal fat pad; S-100; Homatropine methylbromide-45

MeSH Terms

Adipose Tissue
Diagnosis
Immunohistochemistry
Maxillary Sinus
Melanoma*
Nasal Polyps
Rare Diseases
Sinusitis
Transplants

Figure

• 

  Fig. 1 Radiological and clinical images of the right maxillary sinus. A. Buccal mucosal swelling without pigmentation as result of tumor expansion. B. Haziness of the right maxillary sinus and an indistinct alveolar crestal line on panoramic view. C. Cortical bone thinning and expansion on the right maxillary sinus. D. Cortical bone perforation on the anterior wall of the maxillary sinus (white arrow).

• 

  Fig. 2 A. Well encapsulated and partly pigmented soft tissue mass. B. Buccal fat pad graft after tumor excision.

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  Fig. 3 Histological and immunohistochemical image. Melanin pigmentation and mitosis is observed (A; H&E staining, ×400, scale bar=25 µm). Immunohistochemistry with S-100 (B; ×200, scale bar=50 µm) and homatropine methylbromide-45 (C; ×200, scale bar=50 µm).

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