A 49-year-old man with a history of schizoaffective disorder and bipolar disorder presented with nasal airway obstruction, years of intermittent epistaxis, and decreased libido. He denied visual changes, headaches, ear infections, taste disturbance, and anosmia. Physical examination revealed a large bulge in his nasopharynx that effectively reduced his nasopharyngeal airway (Figure 1). He was also found to have gynecomastia and decreased testicular size. Magnetic resonance imaging of his brain demonstrated a normal pituitary gland and a large midline nasopharyngeal mass (Figure 2). An endoscopic nasopharyngeal biopsy was then performed.
Ahmed S, Duong T, Wang MB, Tsai V. Pathology Quiz Case 3. JAMA Otolaryngol Head Neck Surg. 2013;139(1):91. doi:10.1001/jamaoto.2013.1190a