Hayostek, Cherie J.

The maxillary sinus is a rare anatomic site for Hodgkin lymphoma, as only 1 such case has been previously reported in the literature. Nevertheless, we recommend that lymphoma be considered in the differential diagnosis of a mass that involves the maxillary sinus or any other unusual extranodal site in the head and neck. Lymphoma in a patient who presents with disease in an unusual site and without lymphadenopathy is difficult to diagnose. We report the case of a 60-year-old woman who presented with nasal congestion and obstruction. Examination revealed an abnormal-appearing mucosa involving the maxillary sinus. Subsequent evaluation led to a diagnosis of Hodgkin lymphoma. Because making such a diagnosis is difficult, close attention to radiologic and pathologic findings is important. Our review of the literature revealed that treatment commonly includes chemotherapy and radiotherapy, which yield excellent outcomes. The current standard of care for patients with similar-stage Hodgkin lymphoma at other sites can guide the treatment course for patients with extranodal Hodgkin lymphoma.

Biologically malignant pilocytic astrocytomas are rare. Precise morphologic criteria permitting their identification and clinically meaningful distinction from more ordinary pilocytic astrocytomas have not been developed. The histologic grading schemes applied to fibrillary astrocytomas—ones based on nuclear atypia, increased cellularity, mitotic activity, endothelial proliferation, and necrosis—are thought not to correlate with prognosis in pilocytic astrocytomas. Nonetheless, these features were systematically sought in 107 cerebellar pilocytic astrocytomas, four of which were histologically malignant. The clinical, morphologic, and flow cytometric features of these cases were studied. The incidence of histologic malignancy occurring spontaneously in otherwise typical pilocytic astrocytomas was 0.9%; that occurring after radiation was 1.8%. The four histologically malignant tumors occurred in two males and two females, ages 6 to 18 years. All showed increased mitotic activity (three to five mitoses per high-power microscopic field [250×]). Endothelial proliferation and necrosis were present in three and two cases each. DNA ploidy analysis showed the spontaneously occurring malignant-appearing tumors to be aneuploid, whereas both previously radiated tumors were tetraploid; 5% to 11% of cells were in S phase. The appearance of histologic malignancy in pilocytic astrocytoma is rare and less reliably correlated with prognosis than in patients with fibrillary astrocytomas. Essential features of such tumors include a high mitotic index and perhaps a high percentage of cells in S phase. (J Child Neurol 1994;9:301-310).