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Clinical Problem Solving: Pathology
April 2013

Pathology Quiz Case 3: Diagnosis

JAMA Otolaryngol Head Neck Surg. 2013;139(4):428. doi:10.1001/jamaoto.2013.283b

Diagnosis:Pleomorphic adenoma of the nasal septum.

Pleomorphic adenomas of the nasal septum are a rare finding. In the largest published series, Compagno and Wong1 described 40 cases of intranasal pleomorphic adenomas, 25 of which originated from the nasal septum. In their series, the mean age at diagnosis was 42 years, and there was no significant sex predilection. Grossly, the tumors were described as homogeneous, lobular, polypoid, and translucent. Both firm and friable consistencies were described, while tumors ranged from grayish white to pink with occasional reddish brown. Microscopically, the tumors tended to have greater cellularity than major salivary gland pleomorphic tumors, sometimes with no stroma seen at all. Patients were followed for an average of 7.5 years with a recurrence rate of 10%.1 Radiographically, pleomorphic adenomas of the nasal septum have been described as homogeneous, well-defined, soft-tissue masses on CT scan. On magnetic resonance imaging, both Fushiki et al2 and Oztürk et al3 described a low-intensity T1-weighted image and a heterogeneous T2-weighted image.

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