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Clinical Problem Solving: Pathology
July 2005

Clinical Problem Solving: Pathology

Author Affiliations
 

FREDERIC B.ASKINMDWILLIAM H.WESTRAMD

Arch Otolaryngol Head Neck Surg. 2005;131(7):643. doi:10.1001/archotol.131.7.643

A 37-year-old woman presented with a 3-month history of nasal obstruction and recurrent epistaxis on the right side. She was otherwise healthy and had no significant medical history. Physical examination revealed a deviated nasal septum and a polypoid mass arising from the lateral wall on the right side. The findings of the rest of the ear, nose, and throat examination were normal.

The patient subsequently underwent a nasal polypectomy and correction of the deviated nasal septum. During surgery, it was noted that the polyp appeared to arise from the lateral wall of the nose, above the attachment of the middle turbinate. Microscopic examination showed polypoid tissue covered by respiratory epithelium, and the tissue showed undifferentiated malignant cells arranged in sheets and lobules. No fibrillary material or rosette formation was seen (Figure 1). Immunohistochemical analysis showed diffuse staining of tumor cells with synaptophysin (Figure 2) and peripheral staining of the lobules of tumor cells with S100 protein (Figure 3), but the cells stained negatively with epithelial, lymphoid, and melanoma markers. A high-resolution computed tomographic (CT) scan showed soft tissue changes in the ethmoidal air cells that closed the osteomeatal complex, virtually obliterating the frontal compartment and maxillary antrum, with changes abutting the cribriform plate but no apparent bony erosion or intracranial extension (Figure 4).

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