Pathology Quiz Case 1

Abstract

A 49-Y E A R-O L D W O M A N P R E S E N T E D with a 6-month history of right-sided epiphora and a slowly enlarging palpable “bump” on the right side of her nasal wall. She had no remarkable medical history and denied any bloody drainage or pain related to her eye or nose. She also denied using alcohol or tobacco. She was in good health otherwise and had no constitutional symptoms. Physical examination revealed a 2-cm firm, smooth, nontender mass at the right nasal side wall. The mass was nonmobile, and there were no overlying ulcerations or skin changes. The patient’s extraocular movements were intact, and there was no afferent pupillary defect. Some ipsilateral epiphora was present. Nasal endoscopy and a head and neck examination revealed no other abnormalities. Computed tomography of the head showed an expansile 2.6-cm soft-tissue mass following the course of the nasolacrimal duct (Figure 1). The mass, which did not cross the midline, expanded into the right anterior ethmoid sinuses, with no evidence of bony destruction. Subsequent magnetic resonance imaging demonstrated slight heterogeneity on T1and T2-weighted sequences, and there was no evidence of invasion into the orbit. Complete surgical excision of the lesion was performed through an extended Lynch incision, without complication. Hematoxylin-eosin staining demonstrated a welldemarcated nodule punctuated with thick-walled vessels (Figure 2). Immunohistochemical stains were positive (brown) for CD31 and CD34 (Figure 3) as well as for smooth muscle actin and muscle-specific actin (Figure 4). No nuclear atypia was seen. What is your diagnosis?