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Clinical Challenge
June 2015

An Infratemporal Fossa Mass

Author Affiliations
  • 1Department of Otolaryngology, Yale University, New Haven, Connecticut
JAMA Otolaryngol Head Neck Surg. 2015;141(6):575-576. doi:10.1001/jamaoto.2015.0517

A man in his 50s presented with a facial mass growing over 1 year, with 28.5-kg weight loss due to poor oral intake. He reported a 44–pack-year smoking history and remote alcohol abuse. On physical examination he had a 10-cm right-sided facial mass extending under the auricle from the mastoid to the zygoma and inferiorly to the angle of the mandible. The mass was firm, mildly tender, but without overlying skin changes or cervical lymphadenopathy. Computed tomographic (CT) and magnetic resonance imaging (MRI) scans showed maxillary sinus compression with partial destruction of the zygomatic arch, mandible, and orbital floor (Figure, A and B). The mass extended into the right pterygopalatine fossa, disrupting the floor of the middle cranial fossa and widening the foramen ovale. A core biopsy specimen revealed spindle cell proliferation with abundant collagen that stained focally with CD34, smooth muscle actin, and Bcl-2. The Figure, C, shows a gross pathologic image after excision of the mass.Histopathologic findings demonstrated spindle cells arranged in long fascicles with abundant interstitial collagen (Figure, D). Tumor cells exhibited central, oval nuclei, and moderate amounts of pale-pink cytoplasm with indistinct borders. There was no increased or atypical mitosis, necrosis, or vascular invasion. Immunostaining demonstrated strong nuclear staining for β-catenin antibody and was positive for smooth muscle actin antibody, while stains for desmin, pan-keratin, S-100, CD34, and Bcl-2 antibodies were negative. The Ki67 index was less than 1%.