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Clinical Problem Solving: Pathology
April 2013

Pathology Quiz Case 3

JAMA Otolaryngol Head Neck Surg. 2013;139(4):427. doi:10.1001/jamaoto.2013.283a

A 26-year-old Lebanese woman presented with a 3-year history of progressive right nasal obstruction along with recurring episodes of bilateral rhinorrhea and facial pressure, not relieved by antibiotics and nasal steroids. She denied fevers. The physical examination was significant for a leftward deviated septum, hypertrophy of the inferior turbinates, and a bulging pink mass, approximately 1 cm in diameter, in the right anterior nasal cavity adjacent to the nasal septum. Non–contrast-enhanced computed tomographic (CT) scans of the paranasal sinuses showed an ill-defined mass in the region of the right internal nasal valve along with moderate mucosal thickening in the left frontal, ethmoid, and maxillary sinuses, left osteomeatal complex obstruction, and left frontoethmoidal recess obstruction. The patient underwent resection of a right nasal septum mass via endonasal approach, left maxillary antrostomy, left anterior ethmoidectomy, and bilateral inferior turbinate reduction using a microdebrider. A histologic examination of the septal mass (Figure 1) demonstrated a tumor with a predominant epithelial component with chondromyxoid and ductal structures (Figure 2) showing extensive squamous metaplasia (Figure 3). There was no significant atypia, mitotic activity, or necrosis.

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