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Course: Patient With Unilateral Nasal Obstruction and a Nasal Mass

CME Credits: 1.00

Released: 2023-12-07

A 65-year-old man presented to an outpatient department with a 2-year history of left nasal obstruction. He had a history of hypertension and was taking oral medication (amlodipine [5 mg]/valsartan [80 mg] and indapamide [1.5 mg] once daily) but had poorly controlled 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 turbinate outward. Magnetic resonance imaging revealed a well-defined and strongly enhancing mass in the left nasal cavity, with obstructive rhinosinusitis in the frontal and ethmoid sinuses (Figure 1A). 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 examination revealed a 4.8?×-3.0?×-1.8-cm whitish to pink-tan mass lesion (Figure 1B). Histopathological examination revealed sheetlike proliferation of monomorphic ovoid to spindle tumor cells containing ectatic vascular spaces. In addition, immunohistochemical staining showed positive staining for smooth-muscle actin, cyclin D1, and nuclear expression of ?-catenin and negative staining for epithelial membrane antigen, cytokeratin, and CD34.


Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.


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