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Clinical Challenge
August 15, 2019

Progressive Bilateral Nasal Obstruction Due to Nasopharyngeal Mass

Author Affiliations
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
JAMA Otolaryngol Head Neck Surg. 2019;145(10):971-972. doi:10.1001/jamaoto.2019.2254

A healthy Asian man in his 20s presented with a 5-month history of progressive bilateral nasal obstruction. He also complained of recurrent epistaxis. He had no notable medical history except stable asthma. On physical examination, nasopharyngoscopy showed a pedunculated mass with a smooth mucosal surface arising from the roof of the nasopharynx. Computed tomographic (CT) imaging (Figure, A and B) revealed a midline, well-defined, pedunculated polypoid lesion with areas of calcifications in the nasopharynx, measuring approximately 1.2 × 1.5 × 2.0 cm. An endoscopic resection via retrovelar approach using a 70-degree endoscope combined with transnasal approach was performed under general anesthesia. The mass was completely resected with its stalk and with adequate surgical margin. Histopathological results (Figure, C and D) showed that the tumor cells were arranged in papillary structures with fibrovascular cores and these cells also had nuclear grooves. Results of other investigations after surgery were negative for cancer, including magnetic resonance imaging (MRI) of the neck and thyroid ultrasonography. In addition, no residual tumor or systemic metastasis was observed on positron emission tomography (PET)-CT results. There was no evidence of recurrence at 12-month postoperative follow-up.

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