A 66 y.o. woman presents with nasal congestion

What is wrong?

Our patient had a large mass in the nasal cavity.  She had a hx of squamous cancer ten years pta centered over the R forehead and involving the frontal sinus which had been resected. The mass extended into the anterior cranial fossa.  

Nasal masses were first described by Hippocrates in 460 BC.  He is considered the "Father of Rhinology"  because of his description of nasal polyps.  

CAUSES OF NASAL MASSES

BENIGN

The most common benign nasal masses are polyps ( often related to asa allergy) and hemangiomas

encephalocele

CONGENITAL Congenital lesions occur in the first 12 weeks of development  when neural crest cells are migrating.  Lesions  in children include dermoids, hemangiomas, gliomas , encephaloceles, and rhabdomyosarcomas.

VASCULITIS-

Wegener’s is a granuomatosis inflammation  with necrosis occurring in  the respiratory tract, lung and kidney. Sinusitis is the presenting finding in  1/2 to 2/3 of patients.

Rhinoscleroma

INFECTIOUS

Rhinoscleroma is  a chronic bacterial infection caused by Klebsiella rhinocleromatis.

Rhinosporidiosis is a chronic granulomatous disease  endemic in India, Sri Lanka and parts of Africa.  The responsible agent is an a protozoan belonging to a group of fish parasites  and found in water.It stains with fungal stains and  has endospores so for many years it was thought to be a fungus. It causes bony erosion. 

Leprosy- Nasal involvement is universal and occurs early in the disease. The disease is caused by infection with Mycobacterium Leprae.

Tuberculosis, leishmaniasis, blastomycosis, and syphilis have all been reported to cause destructive lesions of the  central face.

leprosy

MALIGNANT:

 Squamous cell cancer is the most common malignancy of the nose accounting for over 90% of tumors.

Lethal midline granuloma ( now known to be an aggressive lymphoma)  is less common. 

Giant cell tumors of the nasal cavity are rare and tend to recur locally. These tumosr have osteoclast-like giant cells and may arise from the nasal septum.

lethal midline granuloma

Our patient had a squamous cell carcinoma of the nose. She underwent surgery. The mass was invading through the cribriform plate into the anterior cranial fossa and a debulking procedure was done endoscopically.

Lathi A, Syed M, Kalakoti P, Kishve S. Clinico-pathological profile of sinonasal masses: a study from a tertiary care hospital of India.  ACTA Otorhinolaryngologica Italica. 2011 Dec;31(6):372-377.

Humayun A, Zahurul H, Ahmed S, et al. Clinicopathological study of sinonasal masses. Bangladesh J Otohinolaryngol. 2010;16:15-22.

Gallo ES, Pehousheck JF, Crowson AN. An exophytic nasal nodule. Arch Dermatol 2010 Jul 146(7) 789-94

Swain S, Ray Ritam. Wegener’s Ganulomatosis of Nose: A case report. 2011 Indian J Otolaryngol Head Neck Surg. Oct 63(4):402-404.