Spindle cell carcinoma of the maxilla: a rare case
The present case has been reported in the journal Surgical Science.

A 34-years-old female, presented in ENT clinic with complaints of left nasal blockage which progressed over 4 months associated with diffuse swelling, pain and hypoesthesia of left cheek. There was left Eye proptosis and decrease vision for 6 months accompanied with loss of left upper molar and premolar tooth.

On examination, there was a non-tender left sided facial swelling which was firm to touch and non-indurated. On anterior Rhinoscopy Nasal cavity failed to show any mass/lesion in the left side while rigid nasopharyngeal scope was also normal. There was loss of left upper molar teeth on left side with granulation tissue which bled on manipulation. The left eye had obvious proptosis with no light perception and no ocular movements while there was no light or pupillary reflex as well.

Rest of ENT and neck examination was unremarkable. Patient was advised Routine labs and C.T head and neck, chest with contrast. After obtaining a computed tomographic image, biopsy was taken from left upper maxillary granulation tissue. C.T scan revealed the lesion to be destructive in nature, occupying the whole left maxilla but surprisingly sparing left nasal cavity.

The histology confirmed the presence of atypical cells with mitotic figures. The tissue was further reviewed under immuno-histochemical stains and the diagnosis of spindle cell carcinoma was confirmed. The patient underwent left subtotal maxillectomy with orbital exenteration while the pterygoid muscle and plates were found to be devoid of disease and temporal fossa extension of the tumour was cleared via tunnel created through the lateral wall of orbit.

Surgery was followed by 2 cycles of cisplatin (30 mg/m2) of chemotherapy and intensity-modulated radiation therapy (IMRT) over the left maxilla for a total of 70 Gy in 35 fractions. The patient remained free of any local or regional recurrence since as reviewed on regular follow up visits and C.T scan at one-year post-surgery.

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