Transnasal resection of epithelioid leiomyoma of the lateral nasal wall

Abstract

This case report highlights the occurrence of a rare epithelioid leiomyoma in the lateral wall of the nasal cavity and subsequent resection. Leiomyomas in the nasal cavity are rare because smooth muscle is sparsely present in this area. For this reason, histological examination is crucial in diagnosing this lesion. Treatment consists of surgical resection of the mass, and recurrences are rare. Here we present a 60-year-old Hispanic male patient with progressive left lateral nasal wall swelling and unilateral nasal obstruction of 3 years evolution. A subcutaneous 1.5 cm soft tissue node was palpated during a physical evaluation in the left lateral nasal wall. Non-contrast maxillofacial CT scan reported mild mucoperiosteal thickening to the floor of the left maxillary sinus and mild undulation of the nasal septum and right middle turbinate. Fine-needle aspiration (FNA) biopsy of the lesion revealed rare epithelioid cells with basaloid features. Mass excision of a 1.0 cm subcutaneous round mass was performed via transnasal approach via an intercartilaginous incision. Microscopic evaluation of the resected mass revealed bundles of well-differentiated spindle-shaped smooth muscle cells. Pathology revealed smooth muscle actin immunoperoxidase stain-positive and desmin immunostain-positive tissue samples, supporting the diagnosis of leiomyoma. After the procedure, the patient's nasal symptoms had entirely resolved, and there was no evidence of recurrence on a one-year follow-up. Leiomyomas are rare in the nasal cavity; thorough clinical, imaging, and pathological evaluation are essential for correctly diagnosing the lesion and resection.