An Unusual Nasal Septal Lesion in an Adult Patient | Oncology | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

An Unusual Nasal Septal Lesion in an Adult Patient

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

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.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

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.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

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.

Article Information

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 (tfalcone@uchc.edu).

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.

References
1.
Hartert  M, Wolf  M, Marko  C, Huertgen  M.  Glomus tumor of the trachea.  Respir Med Case Rep. 2019;28:100905. doi:10.1016/j.rmcr.2019.100905PubMedGoogle Scholar
2.
Cheung  VKY, Gill  AJ, Chou  A.  Old, new, and emerging immunohistochemical markers in pheochromocytoma and paraganglioma.  Endocr Pathol. 2018;29(2):169-175. doi:10.1007/s12022-018-9534-7PubMedGoogle ScholarCrossref
3.
Gombos  Z, Zhang  PJ.  Glomus tumor.  Arch Pathol Lab Med. 2008;132(9):1448-1452.PubMedGoogle Scholar
4.
Kim  JH, Tu  N, Wrobel  BB.  Paraganglioma presenting as a nasal septal mass.  Case Rep Otolaryngol. 2018;2018:1413960. doi:10.1155/2018/1413960PubMedGoogle Scholar
5.
Offergeld  C, Brase  C, Yaremchuk  S,  et al.  Head and neck paragangliomas.  Clinics (Sao Paulo). 2012;67(suppl 1):19-28. doi:10.6061/clinics/2012(Sup01)05PubMedGoogle ScholarCrossref
6.
Fu  YS, Perzin  KH.  Nonepithelial tumors of the nasal cavity, paranasal sinuses and nasopharynx.  Cancer. 1978;42(5):2399-2406. doi:10.1002/1097-0142(197811)42:5<2399::AID-CNCR2820420541>3.0.CO;2-PPubMedGoogle ScholarCrossref
7.
Chou  T, Pan  SC, Shieh  SJ, Lee  JW, Chiu  HY, Ho  CL.  Glomus tumor.  Ann Plast Surg. 2016;76(suppl 1):S35-S40. doi:10.1097/SAP.0000000000000684PubMedGoogle ScholarCrossref
8.
Chirila  M, Rogojan  L.  Glomangioma of the nasal septum.  Ear Nose Throat J. 2013;92(4-5):E7-E9. doi:10.1177/014556131309200420PubMedGoogle ScholarCrossref
9.
Barrett  KE, Barman  SM, Brooks  HL, Yuan  JX-J. Regulation of respiration. In:  Ganong’s Review of Medical Physiology. 26th ed. New York, NY: McGraw-Hill Education; 2019.
10.
Frikh  R, Alioua  Z, Harket  A, Ghfir  M, Sedrati  O.  Glomus tumors.  Ann Chir Plast Esthet. 2009;54(1):51-56. doi:10.1016/j.anplas.2008.05.001PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close