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Clinical Challenge
February 2018

Asymptomatic Septal Mass

Author Affiliations
  • 1William Beaumont Hospital, Troy, Michigan
  • 2Otolaryngology–Head and Neck Surgery, Henry Ford Health System, Charter Township of Clinton, Michigan
JAMA Otolaryngol Head Neck Surg. 2018;144(2):169-170. doi:10.1001/jamaoto.2017.2431

A woman in her 40s presented with a 2-month history of a slowly enlarging, asymptomatic anterior septal mass. She denied a history of localized trauma, substance abuse, or prior endonasal surgery. Examination revealed a nontender, 8-mm, pink-red, soft, fleshy growth just posterior to the membranous septum near the nostril apex. Histopathological analysis demonstrated a well-circumscribed submucosal lesion comprised of bland, round, syncytial cells, arranged in a concentric fashion around variably sized slit-like vascular spaces, a minority of which were staghorn in appearance (Figure, A-C). No significant perivascular hyalinization was identified. The overlying nasal mucosa and surrounding submucosal glands were unremarkable. Immunohistochemical stains demonstrate the cellular population to be strongly positive for smooth-muscle actin (SMA), muscle-specific actin, and CD34 (Figure, D), but negative for B-catenin and epithelial membrane antigen.

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