Endoscopic Resection of Pleomorphic Adenoma of the Nasal Septum

Sinonasal pleomorphic adenoma: A single institution case series combined with a comprehensive review of literatures

OBJECTIVE

This study aimed to reveal diagnosis, management, and treatment outcome characteristics of sinonasal pleomorphic adenoma and to identify predictors for disease recurrence.

METHODS

This study comprised a retrospective review of data from seven patients with sinonasal pleomorphic adenoma who were treated by the authors at a tertiary medical center between January 2005 and May 2017. In addition, the MEDLINE database was searched for literature published in English. A systematic review of the published articles was performed.

RESULTS

A total of 42 articles were eligible for review. Data from the seven treated patients and 101 patients described in the literature were included in the analysis. An endoscopic approach was employed in all cases treated at our institution, and recurrence was found in one patient with a large, 5.5-cm tumor. In reviewing prior publications, the mean age at surgery was 45.4 years, and the primary sign at diagnosis was nasal obstruction. The most common primary tumor site was the nasal septum (57.4%), and the mean tumor size was 3.6cm (range, 0.5-10cm) in 76 cases for which detailed information was available. Endoscopic endonasal resection achieved successful oncologic control in applied cases (25/25, 100%). Recurrence was found in eight of 101 patients. Multivariate analysis identified tumor origin of the paranasal sinus (adjusted OR 31.000, p=0.016) as being significantly associated with a high prevalence of recurrence.

CONCLUSION

Pleomorphic adenoma is a rare benign tumor of the sinonasal tract. Surgery that achieves clear margins is the treatment of choice. The tumor may be accessible via an endoscopic endonasal approach in most cases, although incomplete resection of the tumor stem may allow for tumor recurrence. In addition, our findings suggest that a tumor originating from the paranasal sinus is significantly associated with a high prevalence of recurrence.

Transnasal Endoscopic Resection of a Pleomorphic Adenoma Originate From Nasal Floor

A 81-year-old female presented to our hospital frequent epistaxis. Nasal endoscopy showed a mass obstructing nasal cavity completely and occupying middle meatus. Magnetic resonance imaging was performed, an about 4.8 × 4 × 4.2 cm sized heterogeneous T2 high signal intensity and T1 enhancing mass mainly involving right nasal cavity with invasion of right hard palate with bony destruction. Therefore, the authors planned to do endoscopic mass excision, under general anesthesia for diagnosis and treatment. The authors removed the mass from lateral nasal wall, nasal roof, nasal septum, medial maxillary wall by piece-meal. Margins of mass were clear except the nasal floor. So, the authors did frozen biopsy to confirm the clear margin in nasal floor. Endoscopy enables better visualization of tumor margins, facilitating complete removal and avoiding excessive resection and following up using good visualization.

Giant Intranasal Pleomorphic Adenoma: A Rare Case Report

Pleomorphic adenoma, a heterogeneous mixture of epithelial and myoepithelial cells, commonly found in major salivary glands, accounts for about 3% of benign head and neck tumors. Intranasal pleomorphic adenoma (INPA) is an extremely rare variant forming a mere 8% of all pleomorphic adenomas. Majority of these arise from the nasal septum (82-90%) with only about 8% showing attachment to the lateral nasal wall. Various theories explaining etiopathological basis of INPA have been proposed but none explains its predominance in females in 3rd to 6th decade of life. Hallmark of histopathological picture of pleomorphic adenoma is epithelial tissue mixed with tissues of myxoid, chondroid or mucoid origin. But INPA shows predominantly epithelial component with scanty stroma. Considering its high cellularity and anatomical site, INPA is often misdiagnosed as unilateral nasal malignancy. Early diagnosis ensures complete excision and is paramount to make patient disease free, considering its high potential of recurrence. Hereby, we are presenting a case of giant pleomorphic adenoma of nasal cavity, arising from lateral nasal wall, causing erosion of the base of skull, with the intent of drawing attention to this rare diagnosis.

How to cite this article

Chavan SS, Bhople KS, Vedi JN, Jain PV, Sonavani M. Giant Intranasal Pleomorphic Adenoma: A Rare Case Report. Clin Rhinol An Int J 2013;6(2):96-99.