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Clinical Problem Solving: Pathology
July 2004

Pathology Quiz Case 1

Author Affiliations
 

FREDERIC B.ASKINMDWILLIAM H.WESTRAMD

Arch Otolaryngol Head Neck Surg. 2004;130(7):888. doi:10.1001/archotol.130.7.888

A previously healthy 40-year-old woman presented with a 3-month history of a persistent nasal dorsal mass. The lesion, which had been excised 2 months earlier, had recurred and had been increasing in size. When the patient was a child, she had sustained a nasal fracture that required multiple corrective surgical procedures to straighten out her nasal dorsum and to alleviate nasal obstruction. Examination showed a 2-cm mass on the right side of her nasal bridge, fixed to bone. The mass was slightly tender, erythematous, and firm (Figure 1). There was also a firm, 1.0 × 0.5-cm2 ridge on the right nasal facial crease. Nasal endoscopyshowed a midline adenoid pad and evidence of an inferior turbinate resection on the right side. The findings of the rest of the physical examination were normal. The results of blood tests were unremarkable except for an elevated angiotensin-converting enzyme level (74 U/L). Chest x-ray films showed bilateral hilar adenopathy. Computed tomography of the sinuses revealed no abnormalities. The patient then underwent an excisional biopsy of the nasal dorsal mass. A representative hematoxylin-eosin–stained section of the mass is shown in Figure 2. Stains were negative for fungi and acid-fast bacilli.

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