Indian Journal of Radiology Indian Journal of Radiology  

   Login   | Users online: 452

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size     

 

HEAD NECK AND FACE Table of Contents   
Year : 2005  |  Volume : 15  |  Issue : 3  |  Page : 311-313
Pleomorphic adenoma of nasal septum


Deptt. Of Radiodiagnosis,J.N.M.C.,Aligarh., India

Click here for correspondence address and email
 

   Abstract 

Pleomorphic adenoma is a common,benign tumour arising from the major salivary glands,most commonly from the parotid gland.Ectopic sites for the occurrence of pleomorphic adenomas have been identified in the pharynx,larynx,nasal cavity,trachea and lacrimal glands.We report a case of Pleomorphic adenoma of the nasal cavity arising from the nasal septum.

Keywords: Pleomorphic adenoma - nasal septal tumor

How to cite this article:
Haque F, Babu S, Ahamed S, Ahmad I, Abbas S Z. Pleomorphic adenoma of nasal septum. Indian J Radiol Imaging 2005;15:311-3

How to cite this URL:
Haque F, Babu S, Ahamed S, Ahmad I, Abbas S Z. Pleomorphic adenoma of nasal septum. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Dec 4];15:311-3. Available from: https://www.ijri.org/text.asp?2005/15/3/311/29143

   Introduction Top


Intranasal pleomorphic adenomas are rare,benign tumours which typically grow slowly and have a propensity for recurrence after surgical resection.Computed Tomography(CT) and Magnetic Resonance Imaging(MRI) appearances of intranasal pleomorphic adenomas have been described though a definitive diagnosis of the entity is made by histopathological examination.


   Case report Top


A 18 year old lady was referred to us from the Ear,Nose & Throat(ENT) Department with complaints of progressive nasal obstruction for the last eight years,two episodes of mild epistaxis and gradually enlarging mass involving the right nasal cavity..There was no other relevant past history.On inspection,the lateral wall of the nasal cavity appeared splayed laterally by a mass within the right nasal cavity though the skin over the swelling appeared normal.On anterior rhinoscopy,a lobulated,pale,firm mass was seen involving the entire right nasal fossa.A probe could not be passed around the mass.The mass appeared to arise from the nasal septum and caused deviation of the nasal septum to the contralateral side.The mass did not bleed on manipulation.The rest of the physical examination was normal.

Routine blood and urine examinations were normal.A Roentgenogram of the nose and paranasal sinuses(Water's View)showed a soft tissue density mass involving the right nasal cavity with devation of the nasal septum to the contralateral side..A contrast-enhanced CT of the nose and paranasal sinuses was done obtaining both axial and coronal cut-sections.This revealed a lobulated,soft tissue density mass of size 4.3x5.8 cms in the right nasal cavity attached to the nasal septum.The mass showed homogenous enhancement post intravenous contrast administration.The mass extended up into the ipsilateral anterior ethmoidal air cells and the ipsilateral maxillary antrum with lateral displacement of the lower part of the antero-medial wall of the right maxillary sinus.The ipsilateral inferior turbinate was separately visualized from the mass.The nasal septum was found bowed to the left side with patchy erosion of the nasal septum itself.The base of the skull,infratemporal fossa and frontal sinuses appeared normal.The tumour was excised by wide surgical resection through a lateral rhinotomy approach.The tissue was subjected to histopathological examination which revealed the diagnosis of pleomorphic adenoma.


   Discussion Top


The majority of intranasal pleomorphic adenomas occur between the third and sixth decades of life and are more frequently seen in women[1].The most common presenting complaints include nasal obstruction,epistaxis or a mass in the nasal cavity.The classical clinical findings include a ploypoidal,smooth,lobular,firm mass or nodule with a well-defined capsule.The mass may be friable and may bleed even on gentle manipulation.

Embryologically,salivary glands are derived from out-pouchings of the buccopharyngeal epithelium in the embryo.The outermost strands of the glandular epithelium invade the connective tissue of the capsule.These may be responsible for the ectopic salivary tissue formation at sites such as the cheek,lips,palate,nose,pharynx,neck and trachea[2].

Histological examination of pleomorphic adenomas,irrespective of site,reveal both epithelial and mesenchymal components.Interestingly,histopathological features of intranasal pleomorphic adenomas differ in certain characteristics.Cellularity is usually greater in intranasal tumours and therefore,the epithelial components predominate.Infrequently,the chondroid, myxoid or collagenous stroma may predominate,causing a resemblance to traditional mixed tumours of the major salivary glands[3].Pathlogically,large pleomorphic adenomas of the nasal septum are usually multilobular lesions(4).Local recurrence of intranasal pleomorphic adenomas have also been reported[2].The histopathologic characteristic most frequently associated with recurrent tumour is a myxoid stroma,which could be spilled into the surgical field,providing a nidus for future recurrence[5].

Roentgenogram of the nose and paranasal sinuses(Water's View)may appear normal or may show a lobulated,soft tissue density mass involving either or both the nasal cavities with or without nasal septum deviation.CT of the nose and paranasal sinuses usually reveals a lobulated,soft tissue density mass arising from either the nasal septum or the lateral wall of nasal cavity[6].The mass usually shows heterogenous or irregular enhancement on contrast studies.Calcifications may be an associated finding.The mass may extend into the paranasal sinuses with erosions of their walls.MRI of pleomorphic adenomas of major salivary glands shows a fairly homogenous mass with low T1 and high T2 signal intensity[7].Larger tumours tend to have a lobular contour with or without dystrophic calcification or ossification[7].These larger tumours have a non-homogenous,low-to-intermediate signal intensity on T1-Weighted images and an intermediate-to-high signal intensity on T2-Weighted images[7].Regions of necrosis may also be present and usually have low T1 and high T2 signal intensity.A low-signal-intensity capsule is often seen on T2-Weighted images and on fat-suppressed contrast-enhanced T1-Weighted images[7].The tumour may also show heterogenous,high-signal-intensity on fast short-inversion-time-inversion-recovery (fast-STIR)sequences[1].Fat-suppressed contrast-enhanced T1-Weighted spin-echo images may show marked curvilinear enhancement with small,unenhanced foci[1].

The differential diagnosis of intranasal pleomorphic adenomas include both benign and malignant tumours such as squamous cell carcinoma,inverted papilloma,adenocarcinoma,sinonasal melanoma,cartilaginous tumour from the nasal septum or schwannoma.The presence of eroded bone and calcification suggests an aggressive malignant neoplasm rather than a slow-growing,benign tumour.


   Conclusion Top


Pleomorphic adenomas of the nasal septum show characteristic CT and MRI features and the entity should be considered in the differential diagnosis of multilobular tumours involving the nasal cavity.Wide surgical excision with follow-up to detect reccurrence appears to be the most appropriate line of management of intranasal pleomorphic adenomas.[8]

 
   References Top

1.Motoori K,Hideyuki T,et al.Pleomorphic adenoma of the nasal septum:MR features.Americal Journal of Neuroradiology 2000;21:1948-1950.  Back to cited text no. 1    
2.Gill BS,Rekhi BM.Pleomorphic adenoma of the nose-A case report.Indian Journal of Otolaryngology 1968;vol XX,No.3:132-134.  Back to cited text no. 2    
3.Compagno J,Wong RT.Intranasal mixed tumours(pleomorphic adenomas):a clinicopathologic study of 40 cases.Americal Journal of Clinical Pathology 1977;68:213-218.  Back to cited text no. 3  [PUBMED]  
4.Jassar P,Stafford ND,MacDonald AW.Pleomorphic adenoma of the nasal septum.Pathology in focus.Journal of Laryngology and Otology 1999;113:483-485.  Back to cited text no. 4    
5.Krolls SO,Boyers RC.Mixed tumours of salivary glands.Long-term follow-up.Cancer 1972;30:276-281.  Back to cited text no. 5    
6.Suzuki K,Moribe K,Baba S.A rare case of pleomorphic adenoma of lateral wall of nasal cavity with special reference of statistical observation of pleomorphic adenoma of nasal cavity in Japan.Nippon Jibiinkoka Gakkai Kaiho 1990;93:740-745.  Back to cited text no. 6  [PUBMED]  
7.Som PM,Brandwein M.Salivary glands.In:Som PM,Curtin HD,eds.Head and Neck Imaging 3rd ed.St.Louis,Mo:1996;879-882.  Back to cited text no. 7    
8.Clark M,Fatterpekar GM,Mukherji SK,Buenting J.CT of Intranasal Pleomorphic Adenoma. Neuroradiology, 1999; 41: 591-93.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]

Top
Correspondence Address:
F Haque
41, Alig Appartments, Shamshad Market, Aligarh - 202002
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.29143

Rights and Permissions


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Pleomorphic adenoma of the infratemporal fossa: Case report and literature review
Gurey, L.E., Brook, C.D., Parnes, S.M.
Laryngoscope. 2010; 120(supp 4): s151
[Pubmed]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Case report
    Discussion
    Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed5293    
    Printed129    
    Emailed1    
    PDF Downloaded300    
    Comments [Add]    
    Cited by others 1    

Recommend this journal