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A 31-year-old female patient presented with right nasal pain and radiating facial pain over the previous 3 years. She reported feeling a mass in her right nostril that had not changed in size, as well as associated nasal tenderness to the external nose, worsening pain with exposure to cold temperatures, and frequent sneezing. Prior to presentation, she had been prescribed fluticasone and loratadine for allergic rhinitis without resolution of symptoms. She denied difficulty breathing, epistaxis, rhinorrhea, fever, chills, weight loss, or night sweats. She was a nonsmoker and nondrinker. On physical examination, her external nose had no visible lesions. A rhinoscopy revealed normal mucosa with a submucosal, round, firm, tender lesion, measuring approximately 1 cm and located on the right anterior nasal septum. No drainage was visualized. Her turbinates appeared normal. The patient underwent surgical excision of the septal lesion under general anesthesia for definitive diagnosis. The specimen measured 1.1 × 0.7 × 0.2 cm and was erythematous, soft, vascular, and adherent, with a broad base to the anterior superior nasal septal mucosa just inferior to the upper lateral cartilage (Figure 1A and B). The lesion was excised down through the perichondrium.
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A. Glomus tumor
Histopathologic findings showed that no malignant neoplasm was identified (Figure 2A). Results from immunohistochemical analysis were positive for actin (Figure 2B), and stains for the E3 ubiquitin–protein ligase MIB1 protein demonstrated a low proliferation index (Figure 2C). The excised mass was composed of small, round cells arranged around vessels, and Figure 2D highlights this surrounding vasculature with CD31 immunostaining. Histopathological testing confirmed that this lesion was a glomus tumor, specifically a glomangioma. On histological testing, this lesion did not show the characteristic endophytic or inverted growth pattern seen in inverted papillomas, which consists of a markedly thickened squamous epithelial proliferation growing downward into the underlying connective tissue stroma. It also did not express the classic hyalinized, branching, staghorn, thin-walled vessels lined by flattened endothelium commonly seen in hemangiopericytomas.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Todd E. Falcone, MD, Division of Otolaryngology–Head and Neck Surgery, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030 (firstname.lastname@example.org).
Published Online: December 12, 2019. doi:10.1001/jamaoto.2019.3836
Conflict of Interest Disclosures: Dr Falcone serves as a consultant to GI Reviewers LLC. No other disclosures were reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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