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Clinical Challenge
April 2015

Worsening Headache and Nasal Congestion

Author Affiliations
  • 1Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles
  • 2Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles
JAMA Otolaryngol Head Neck Surg. 2015;141(4):387-388. doi:10.1001/jamaoto.2014.3539

A woman in her 50s presented with an 8-week history of increasing headache, hyposmia, hypogeusia, and nasal congestion. Endoscopic nasopharyngoscopy revealed a large polypoid nasal mass occupying the left nasal roof and completely obstructing the nasal passage. Contrast-enhanced T1-weighted magnetic resonance imaging (MRI) revealed a 1.7 × 3.5 × 2.6-cm soft-tissue mass within the left ethmoid cavity, eroding through the cribriform plate with adjacent dural enhancement (Figure, A). Intraoperative pathologic examination showed polypoid spindle cell proliferation. Histopathologic findings showed respiratory epithelium with submucosal vascular proliferation with no atypia among the lining endothelial cells. The Figure, B, shows a central vessel surrounded by lobules of endothelial lined capillaries. The Figure, C, highlights the endothelial cells of the numerous capillaries and the central vessel.

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