Inflammatory pseudotumor presenting as a facial swelling [Upalni pseudotumor koji se manifestira kao oteklina lica]

Dediol, Emil and Manojlović, Spomenka and Tomasović Lončarić, Čedna and Biočić, Josip and Hat, Josip (2012) Inflammatory pseudotumor presenting as a facial swelling [Upalni pseudotumor koji se manifestira kao oteklina lica]. Collegium Antropologicum, 36 (S. 2). pp. 143-146. ISSN 0350-6134

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Abstract

We present a case of inflammatory pseudotumor (IPT) presenting as a facial swelling after an accidental hit on a right side of a face. As swelling did not resolve, dental examination and teeth extraction were done by a dentist presuming the swelling was misdiagnosed with infection of dental origin. Swelling grew even bigger and patient was referred to Department of Maxillofacial Surgery. CT scan of the face and FNA of the lesion was ordered. A homogenous tumor mass in the right infraorbital region in front of anterior wall of the maxillary sinus was seen on CT The result of the FNA was reactive hyperplasia of the lymph node. Since the lesion was easily accessible surgical exploration and complete extirpation was done. Pathohistological analysis indicated a low grade B-cell Non Hodgkin lymphoma. PCR showed policlonality of B cells discarding the diagnosis of lymphoma. Pathohistological review showed diffuse intramuscular, perineural and perivascular infiltration with small lymphocytes without formation of germinative centers. Imunohistochemistry was positive for CD20 and CD3. Taking into account all features the diagnosis of IPT was established. Diagnosis of IPT is a diagnosis by exclusion, combining clinical, radiological and pathohistological characteristics. Lack of clear histologic criteria makes differential diagnosis extremely difficult. Our case is unique regarding localisation of head & neck IPT no case presenting on the face in infraorbital region has been described in the literature. Although IPT is very rare in general and especially on the face, one should be aware of it when considering differential diagnosis of facial swelling.

Abstract in Croatian

Prikaz slučaja upalnog pseudotumora na licu kod pacijenta koji je primio slučajni udarac u desnu stranu lica. Nakon što oteklina od udarca nije splasnula pacijenta je pregledao stomatolog koji je izvadio zube sumnjajući na oteklinu odontogene etiologije. Oteklina je bila i dalje sve veća te je upućen na Kliniku za maksilofacijalnu kirurgiju. Napravljeni su CT lica i citološka punkcija lezije. CT je pokazao homogenu tumorsku masu infraorbitalno desno s prednje strane maksile. Po citološkoj punkciji radilo se o reaktivnoj hiperplaziji limfnog čvora. S obzirom da je lezija bila lako dostupna učinjena je kirurška eksploracija i ekstirpacija. Patološka analiza je govorila u prilog Non Hodgkin lifoma B stanica niskog stupnja. PCR-om je dokazana pak poliklonalnost B stanica odbacujući dijagnozu limfoma. Patohistološka revizija je pokazala difuznu intramuksularnu, perineuralnu i perivaskularnu infiltraciju malim limfocitima bez formiranja germinativnih centara. Imunohistokemija je bila pozitivna na CD20 i CD3. Uzimajući u obzir sve značajke postavljena je dijagnoza upalnog pseudotumora. Dijagnoza upalnog pseudotumora se postavlja na temelju isključenja, kombinirajući kliničke, radiološke i patohistološke karakteristike. Nedostatak jasnih histoloških kriterija čini diferencijalnu dijagnozu izuzetno teškom. Naš slučaj je jedinstven po lokalizaciji pseudotumora na glavi i vratu, nije još objavljen slučaj pseudotumora na licu u infraorbitalnoj regiji. Iako je općenito upalni pseudotumor rijedak a pogotovo na licu, treba ga imati na umu kada mislimo o diferencijalnoj dijagnozi otekline na licu.

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