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Clinical Challenge
Pathology
December 12, 2019

An Unusual Nasal Septal Lesion in an Adult Patient

Author Affiliations
  • 1University of Connecticut School of Medicine, Farmington
  • 2Pathology and Laboratory Medicine, University of Connecticut School of Medicine, Farmington
  • 3Division of Otolaryngology–Head and Neck Surgery, University of Connecticut School of Medicine, Farmington
JAMA Otolaryngol Head Neck Surg. 2020;146(3):300-301. doi:10.1001/jamaoto.2019.3836

A 31-year-old female patient presented with right nasal pain and radiating facial pain over the previous 3 years. She reported feeling a mass in her right nostril that had not changed in size, as well as associated nasal tenderness to the external nose, worsening pain with exposure to cold temperatures, and frequent sneezing. Prior to presentation, she had been prescribed fluticasone and loratadine for allergic rhinitis without resolution of symptoms. She denied difficulty breathing, epistaxis, rhinorrhea, fever, chills, weight loss, or night sweats. She was a nonsmoker and nondrinker. On physical examination, her external nose had no visible lesions. A rhinoscopy revealed normal mucosa with a submucosal, round, firm, tender lesion, measuring approximately 1 cm and located on the right anterior nasal septum. No drainage was visualized. Her turbinates appeared normal. The patient underwent surgical excision of the septal lesion under general anesthesia for definitive diagnosis. The specimen measured 1.1 × 0.7 × 0.2 cm and was erythematous, soft, vascular, and adherent, with a broad base to the anterior superior nasal septal mucosa just inferior to the upper lateral cartilage (Figure 1A and B). The lesion was excised down through the perichondrium.

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