A 32-year-old Caucasian male from Playas de
Jaco (Puntarenas, Costa Rica), was admitted to
the hospital in June 1979. Two months before
seeking medical attention the patient had noticed
progressive, painless swelling of the left zygomatic
and paranasal area, accompanied by left nasal
obstruction and difficulty in breathing. Soon af
terwards he noticed a hard nodule in the skin of
the face. There was no history of trauma or evi
dence of insect bites. Clinical examination re vealed that the patient was in general good health
with abnormal findings limited to the face (Fig.
1). The nose and paranasal tissues, mainly on the
left side, were enlarged by the presence of a thick
ened skin without ulcération. On the left side, a hard subcutaneous nodule was present. The mu
cosa of the left nasal cavity was deeply congested
and edematous. The clinical diagnosis was carci noma of the maxillary antrum. On radiological
examination, a diffuse opacity without bone de
struction was seen in the left paranasal sinus. Rel
evant data included: hemoglobin lS.Sg%