A 71-year-old female patient presented with a 4-year history of progressive right-sided nasal obstruction accompanied by ipsilateral epiphora, without epistaxis or olfactory disturbances.
On physical examination, the patient had visible nasal deformity. Anterior rhinoscopy showed a vascular, polyp-like lesion filling the right nasal passage, extending forward into the vestibule and displacing the septum. Imaging with computed tomography showed near-complete obstruction of the right nasal cavity by a tissue mass, with bulging of the medial wall of the maxillary sinus without evidence of bone lysis and leftward septal deviation.
Biopsy findings were initially consistent with a differentiated, keratinizing, invasive squamous cell carcinoma. The patient subsequently underwent endoscopic surgical removal of the lesion. During the procedure, surgeons found a well-encapsulated tumor attached to the nasal septum, which they removed completely with clear margins. The procedure also included a right maxillectomy with exploration and clearance of the maxillary sinus.
Definitive histopathologic evaluation of the resected lesion supported a diagnosis of pleomorphic adenoma, with mixed epithelial and mesenchymal components within a myxoid background and associated squamous metaplasia without cytologic atypia.
No intraoperative complications were reported. At 3 months, follow-up showed resolution of epiphora and no evidence of recurrence, along with improvement in nasal swelling. At 6 months, there continued to be no signs of recurrence, although asymmetry of the nasal pyramid persisted.
Pleomorphic adenoma arising in the nasal cavity is uncommon and can resemble malignant disease in both presentation and microscopic appearance. This overlap has been linked to its relatively high cellularity and limited stromal component compared with tumors of the major salivary glands.
Diagnostic confusion has been reported, including cases initially classified as squamous cell carcinoma. Management typically involves complete removal of the lesion with clear margins, which is also required for definitive diagnosis. Ongoing monitoring is advised given the risk of recurrence and the possibility of malignant change.
The researchers reported no conflicts of interest.
Source: Otolaryngology Case Reports
