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Clinical Challenge
Pathology
February 2017

Nasal Dorsum Mass in an Infant

Author Affiliations
  • 1Columbia University College of Physicians and Surgeons, New York, New York
  • 2Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
  • 3Department of Otolaryngology–Head and Neck Surgery, Columbia University Medical Center, New York, New York
JAMA Otolaryngol Head Neck Surg. 2017;143(2):187-188. doi:10.1001/jamaoto.2016.0491

An infant girl who was initially seen in the neurosurgical clinic at 7 weeks of age for a left parietal scalp cyst was referred to our clinic after the neurosurgeon discovered a new nasal midline mass on follow-up examination. Her perinatal and medical histories were otherwise unremarkable. On examination, a 1-cm mobile, well-defined, nontender mass over the nasal dorsum was noted. Findings from the rest of the otolaryngologic examination were normal. Given the superficial nature of the nasal cyst on examination and in an effort to minimize radiation and anesthetic exposure for the patient, computed tomographic and magnetic resonance imaging were deferred. The preoperative plan was to excise the nasal dermal lesion and carefully inspect for any tracts extending intracranially, which would then warrant imaging and a revised intracranial approach. Intraoperatively, an incision was made above the mass and carried through the subcutaneous tissue to expose a mass with a white wall and pink tissue within. The 0.8 × 0.5 × 0.3-cm mass was freed from the surrounding tissue and excised down to the nasal bone. Careful inspection and palpation after excision revealed no bone involvement or intracranial extension. The neurosurgical team removed the superficial scalp cyst, which was found to be an epidermoid cyst. Histopathologic images of the excised nasal mass are shown in the Figure.

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