Leiomyoma of the nasal cavity Report of a case By THOMAS V. MCCAFFREY, THOMAS J. MCDONALD and KRISHNAN K. UNNI (Rochester, Minnesota)

are benign tumours of myogenic origin that may occur wherever smooth muscle is present. They are common in the uterus and can frequently occur in the walls of the alimentary canal and in subcutaneous tissue. They are uncommon in the upper aerodigestive tract, and only three cases of this benign neoplasm arising within the nasal cavity have been reported (Maesaka et al., 1966; Fu and Perzin, 1975). This is a report of a vascular leiomyoma arising from the inferior nasal turbinate. LEIOMYOMAS

Report of a case A 76-ycar-old white woman was seen at the Mayo Clinic because of intermittent hoarseness. Examination of the larynx revealed no abnormalities. Examination of the nasal cavity revealed a 0-5 cm diameter submucosal mass situated on the anterior margin of the left inferior turbinate. The mucosa overlying this mass was slightly abraded. The patient's only nasal symptoms were intermittent painless bleeding and crusting from the left nostril. Sinus roentgenograms showed slightly thickened mucosa of the left maxillary sinus. An excisional biopsy of the left nasal mass was performed under local anesthesia, and the mass was identified histologically as a vascular leiomyoma of 0-4 cm diameter (Fig. 1). The lesion was well circumscribed and was situated just under the mucosa. Even under low power, numerous thick-walled blood vessels were obvious. The tumour was composed of spindle cells with a focal myxoid stoma. The vessels had narrow lumina and thick walls. The cells that formed the walls had the same myogenic quality as the spindle cells that formed the bulk of the tumour. In areas, the cells of the blood vessel walls seemed to merge into the remainder of the tumour (Fig. IS). Discussion

The first reported case of an intranasal leiomyoma was in 1966 by Maesaka et al. (Table I). The lesion involved the nasal vestibule of a 49-year-old woman. The only other report of a nasal leiomyoma describes two patients with leiomyomas; both of the lesions were found incidentally in specimens of nasal polyps (Fu and Perzin, 1975). One patient was a 60-year-old woman and the other was a 46-year-old man. All of the tumours were small (less than 2 cm. in diameter). Both vascular and non-vascular leiomyomas have been reported. Only one of the nasal leiomyomas has been reported as being painful (Maesaka et al., 1966). This is unlike subcutaneous leiomyomas, either the vascular or the nonvascular type, which are almost always painful (Stout, 1937). The small size of these tumours and the lack of symptoms may account for the Infrequency with which these tumours are identified in the nose. 817

8 1 8 THOMAS V. MCCAFFREY, THOMAS J. MCDONALD AND KRISHNAN K. UNNI

CLINICAL RECORDS

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TABLE I LF.1OMYOMA OF THE NASAL CAVITY

Authors Maesaka el ul. (1966) Fu and Perzin(l975) McCaffrey el al. (present study)

Sex and age (yrs) F, 49 F, 60 M.46 F, 76

Location

Symptoms

Type

Vestibule Nasal polyp Nasal polvp Inferior turbinate

Pain None None Bleeding

Vascular Non-vascular Non-vascular Vascular

Smooth-muscle tumours of the nasal cavity are extremely rare, probably because so little smooth muscle is present in the nasal cavity. The media of blood vessels is the only location in which smooth muscle is normally found in the nasal cavity. There is some controversy as to the nature of vascular leiomyomas. Duhig and Ayer (1959) suggested that some vascular leiomyomas may not be true neoplasms but are vascular malformations determined by the combination of trauma and elevated levels of estrogen. They suggested a progression of the lesion from haemangioma to angioma with much non-striated muscle, to vascular leiomyoma, to leiomyoma with many vessels, and finally to solid leiomyoma. The evidence for this hypothesis is indirect and is based on the observed age and sex of the patients and on the site distribution of the tumours. The vascular leiomyomas that they observed occurred primarily in women between the ages of 30 and 50 years, the site of origin being primarily those regions subject to trauma. Of four patients with leiomyoma of the nasal cavity, three have been females and the ages at the time of diagnosis have ranged from 49 to 76 years. The lesions have been associated with trauma or inflammation; the two patients described by Fu and Perzin (1975) had associated inflammatory polyps, while the present patient had associated intermittent traumatic bleeding. Whether the leiomyomas of the nasal cavity are true neoplasms or vascular malformations, they are clinically benign, and recurrences have not been reported after complete excision. No malignant degeneration has been noted in nasal leiomyomas. The most satisfactory treatment for these lesions is complete excision if they become symptomatic or if there is doubt concerning the nature of the lesion. The true prevalence of these lesions is probably considerably greater than is indicated by the rarity of reports. Summary

A 76-year-old woman had a leiomyoma of the nasal cavity. There are three cases of leiomyomas of the nasal cavity previously reported. REFERENCES DUHIG, J. T., and AYER, J. P. (1959) Archives of Pathology, 68, 424. Fu, Y.-S., and PFRZIN, K. H. (1975) Cancer, 35, 1300. MAESAKA, A., KEYAKI, Y., and NAKAHASHC, T. (1966) Otologia (Fukuoka), 12, 42.

STOUT, A. D. (1937) American Journal of Cancer, 29, 435. Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN 55901, U.S.A.

Leiomyoma of the nasal cavity. Report of a case.

Leiomyoma of the nasal cavity Report of a case By THOMAS V. MCCAFFREY, THOMAS J. MCDONALD and KRISHNAN K. UNNI (Rochester, Minnesota) are benign tumo...
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