xRead - Nasal Obstruction (September 2024) Full Articles

Clinical Review & Education

Clinical Challenge | PATHOLOGY

Patient With Unilateral Nasal Obstruction and a Nasal Mass

Yan-Ting Ho, MD; Li-Yu Lee, MD; Chia-Hsiang Fu, MD, PhD

A Magnetic resonance imaging

B Gross examination of tumor

Figure1. A, Magnetic resonance imaging (T2-weighted) shows a hypervascular tumor over left nasal cavity with obstructive rhinosinusitis at frontal and ethmoid sinuses. B, Gross examination reveals a 4.8 × 3.0 × 1.8-cm whitish to pink-tan tumor.

A 65-year-old man presented to an outpatient department with a 2-year history of left na sal obstruction. He had a history of hypertension and was taking oral medication (amlo dipine [5 mg]/valsartan [80 mg] and indapamide [1.5 mg] once daily) but had poorly con trolled systolic blood pressure ranging from 130 to 160 mm Hg. No associated trauma or surgical history was reported. Physical examination revealed a large tumor originating from the olfactory groove in the left nasal cavity, with feeding vessels pushing the middle turbi nate outward. Magnetic resonance imaging revealed a well-defined and strongly enhanc ing mass in the left nasal cavity, with obstructive rhinosinusitis in the frontal and ethmoid sinuses ( Figure 1 A). During surgical exploration, the tumor abutted the superior end of the nasal septum near the cribriform plate. Tumor excision was completed with a surgical margin of at least 5 mm, with the perichondrium of the nasal septum as the deep margin. The feeding vessels of the tumors were cauterized during the resection. Gross examina tion revealed a 4.8 × 3.0 × 1.8-cm whitish to pink-tan mass lesion (Figure 1B). Histopatho logical examination revealed sheetlike proliferation of monomorphic ovoid to spindle tu mor cells containing ectatic vascular spaces. In addition, immunohistochemical staining showed positive staining for smooth-muscle actin, cyclin D1, and nuclear expression of β-catenin and negative staining for epithelial membrane antigen, cytokeratin, and CD34.

WHAT IS YOUR DIAGNOSIS?

A. Lobular capillary hemangioma

B. Inverted papilloma

C. Glomangiopericytoma

D. Solitary fibrous tumor

CME Quiz at jamacmelookup.com

Diagnosis C. Glomangiopericytoma

cular myoid differentiation with a relatively benign clinical course. 3,4 It was described as an indolent tumor with low malignancy poten tial and accounts for less than 0.5% of all sinonasal tumors. 5,6 There is a slight female predominance reported and it commonly occurs in patients in the sixth and seventh decades of age. 2,4 Thecommon clinical manifestations include nasal obstruction and epistaxis. 2,6 GPC is usually large in size when diagnosed due to its indolent charac teristic and nonspecific presentations.

Discussion Sinonasal glomangiopericytoma (GPC) is a relatively rare mesen chymal neoplasm located in the nasal cavity and paranasal sinuses. 1,2 It was first described by Stout and Murray in 1924 and was initially categorized as a hemangiopericytomalike neoplasm with perivas

(Reprinted) JAMA Otolaryngology–Head & Neck Surgery February 2024 Volume 150, Number 2 179

jamaotolaryngology.com

© 2023 American Medical Association. All rights reserved.

Downloaded from jamanetwork.com by Stanford University Medical Center user on 07/02/2024