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Clinical Problem Solving: Pathology
April 2002

Pathology Quiz Case 1

Author Affiliations
 

FREDERIC B.ASKINMDWILLIAM H.WESTRAMD

Arch Otolaryngol Head Neck Surg. 2002;128(4):452. doi:10.1001/archotol.128.4.452

A 77-YEAR-OLD MAN presented with a 1-week history of increasing right nasal swelling. He had not noticed nasal congestion or tenderness associated with the mass, and he denied trauma to the face or nose. He had no fever, chills, purulent nasal drainage, or facial numbness. His medical history was significant for hypertension, type 2 diabetes mellitus, and alcohol abuse; he also had a 90 pack-year history of smoking.

On physical examination, a 3-cm cystic mass was observed posterior to the nasal ala and anterior to the maxilla on the right. The nasal vestibule was raised on the right, and the right nasolabial fold was effaced on the same side. A computed tomographic scan (Figure 1 and Figure 2) showed a 2.5-cm cystic mass abutting the anterior aspect of the right maxilla. Bone remodeling, without invasion, was present, and there was no separation of the maxilla underlying the mass. An incidental finding of a 1.5-cm cystic mass on the left posterior alveolar ridge was noted.

The patient underwent surgical excision of the cystic nasal mass under general anesthesia. A sublabial incision was used for access (Figure 3), allowing the mass to be dissected free from the labial mucosa and maxilla. The mass was firmly attached to the nasal mucosa, which had to be transected and repaired. The histologic features of the cyst wall are shown in Figure 4. The patient had an uncomplicated postoperative course. He was without evidence of recurrence 24 months after surgery.

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