PRESENTATION OF CASEA 43-year-old male patient presented with a 1.5-year history of progressive left nasal septal mass (Fig.1) leading to left nasal obstruction for the last 1-1.5 years, two to three episodes of mild epistaxis and gradually enlarging mass involving the left nasal cavity. There was no history of previous trauma, surgeries or visual defect. His general health was satisfactory with a stable weight.
DIFFERENTIAL DIAGNOSISSalivary gland tumours account for about 3% of all neoplasms, the majority being benign and about 70% are pleomorphic adenomas. A small minority are also located in nasal cavity, neck and oral cavity. In this case report, we are presenting a rare case of pleomorphic adenoma of the nasal septum. Nasal septum is a discrete area of erectile tissue in the submucosa over the anterior nasal septum. In most cases, it can present as a suspicious lesion. Several benign lesions of the septum like leiomyoma, osteochondroma and transitional cell papilloma can be considered. Other malignant tumours such as melanoma, adenoid cystic carcinoma and squamous cell carcinomas may be the differential diagnosis. The majority of these tumours arise from the mucosa of the bony and cartilaginous septum. However, depending on the size and location, the diagnosis may be considered. 'Financial or Other Competing Interest': None. Submission 09-09-2017, Peer Review 03-10-2017, Acceptance 09-10-2017, Published 30-10-2017
CLINICAL DIAGNOSISThe lateral wall of nasal cavity was splayed laterally by a mass within the left nasal cavity, while the skin over the swelling appeared normal. Anterior rhinoscopy revealed a friable polypoid mass involving the left nasal cavity. A probe could not be passed around the mass, neither did it bleed on manipulation. The mass appeared to arise from the nasal septum but caused minimal or almost no deviation of the nasal septum to the opposite side. There was no evidence of rhinosinusitis and his postnasal space was also normal. There were no palpable lymph nodes. Radiological examination (CT scan) demonstrated a well-defined cystic mass in the anterior part of the septum of the left nasal cavity with well pneumatised paranasal sinuses (Fig. 2). Furthermore, the smooth surface, preservation of mucosal lining and the localised nature of the mass seen in nasal endoscopy were consistent with the benign lesion.
DISCUSSION OF MANAGEMENTAn intranasal resection of the mass was done and the sample (Fig. 3, 4) was sent for biopsy. The histopathological analysis of the tumour confirmed a benign pleomorphic adenoma with no focus of malignant change. The patient was discharged on day 3, and the postoperative course was uneventful. After a month, on followup, the patient had no nasal complaints (Fig.