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Clinical Problem Solving: Pathology
June 2002

Pathology Quiz Case

Author Affiliations
 

FREDERIC B.ASKINMDWILLIAM H.WESTRAMD

Arch Otolaryngol Head Neck Surg. 2002;128(6):721. doi:10.1001/archotol.128.6.721

A 3-MONTH-OLD BOY presented with a nasal mass that he had had since birth. According to the his mother, the mass had slowly been getting larger and was now causing some nasal obstruction and difficulty in his nasal breathing. His mother described occasional snoring and intermittent episodic epistaxis. The birth history was unremarkable; the patient had never been hospitalized and had never undergone surgery. His medical history also was unremarkable. His family history was notable for sinus disease, cancer, reflux, and ear infections on the maternal side. A review of systems revealed swollen eyes, nasal congestion, and daytime cough accompanied by a runny nose, sneezing, and restless sleep.

Physical examination revealed a well-appearing child in no respiratory distress. His facial structures were remarkable for a broad nasal dorsum. Anterior rhinoscopy showed a large mass originating from the lower lateral cartilage and completely obstructing the right nostril. It appeared to extend to the superior part of the vestibule, but the extent of the entire lesion could not be determined by anterior rhinoscopy alone. Palpation of the mass showed a smooth, rubbery lesion that did not blanche with direct pressure. The lesion was nonpulsatile and did not change in size when the patient cried. Examination of the scalp, ears, oral cavity, and neck revealed no abnormalities. A computed tomographic scan and a magnetic resonance imaging scan showed a 0.7 × 1.8 × 1.1-cm soft tissue mass in the anterior right nasal cavity (Figure 1), without extension into the bony nasal framework, nasopharynx, paranasal sinuses, or skull base. No bony erosion was observed.

A transnasal excision of the mass was performed with endoscopic guidance. The mass was excised from vestibular skin without difficulty, and a small mucosal attachment from the inferior turbinate was freed with electrocautery. Grossly, the lesion, which was dense and glistening, was a small, tan, white, and focally red mass. The histopathologic features of the lesion are shown in Figure 2 and Figure 3.

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