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Clinical Challenge
Radiology
May 16, 2019

Incidental Nasal Cavity Mass Identified During Preoperative Examination for Transsphenoidal Surgery

Author Affiliations
  • 1Department of Neuroradiology, University of Virginia Health System, Charlottesville
  • 2Department of Surgical Pathology, University of Virginia Health System, Charlottesville
JAMA Otolaryngol Head Neck Surg. 2019;145(7):682-683. doi:10.1001/jamaoto.2018.3983

An 80-year-old man with acromegaly due to a hypoenhancing pituitary microadenoma opted for transsphenoidal resection. Preoperative magnetic resonance imaging examination of the sella revealed a left-sided pituitary microadenoma (Figure, A) and lobulated polypoid soft tissue masses in the superior nasal cavities arising from the olfactory clefts. These lesions demonstrated avid post–contrast enhancement with small areas of cystic change and heterogeneously hyperintense T2 signal. There was mild widening of the olfactory clefts, particularly on the left side (Figure, B). The intervening nasal septum was intact, and there was no intracranial extension. The patient did not have any noteworthy rhinological symptoms on review. He later underwent nasal endoscopy, and results showed tan-colored polypoid lesions emanating from the olfactory clefts of both nasal cavities (Figure, C). Biopsy findings revealed submucosal proliferation of seromucinous and respiratory epithelial glands (Figure, D).

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