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Clinical Challenge
July 30, 2020

A Case of Persistent Frontal Swelling

Author Affiliations
  • 1University of Mississippi Medical School, Jackson
  • 2Department of Pathology, University of Mississippi Medical Center, Jackson
  • 3Department of Otolaryngology–Head and Neck Surgery, University of Mississippi Medical Center, Jackson
JAMA Otolaryngol Head Neck Surg. Published online July 30, 2020. doi:10.1001/jamaoto.2020.1610

An 85-year-old woman with a history of arthritis, hypercholesterolemia, hypertension, and glaucoma presented to the clinic for evaluation of chronic sinusitis. Symptoms included a several-year history of frontal pain, pressure, clear nasal discharge, and progressive nontender facial swelling above her glabella. She denied nasal disturbance, prior sinus surgery, asthma, or acetylsalicylic acid (aspirin) sensitivity. Symptoms were refractory to treatment with several rounds of oral antibiotics and oral steroids. Physical examination findings revealed symmetric facial movement with prominent glabellar swelling and soft tissue thickening. Nasal endoscopy findings revealed a soft tissue mass anterior to the axilla of the middle turbinates bilaterally, with normal-appearing mucosa overlying. Computed tomography and magnetic resonance imaging (MRI) scans were obtained for further evaluation (Figure, A). Recommendations were made to proceed to the operating room for biopsy of the nasal mass. Pathology results revealed uniform, epithelioid cells arranged in a whorled, lobulated growth pattern without atypia, necrosis, increased cellularity, or diffuse growth pattern (Figure, B and C).

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