Nasal Pleomorphic Adenoma Misdiagnosed as Squamous Cell Carcinoma
Overview
A 71-year-old woman with progressive nasal obstruction was initially misdiagnosed with squamous cell carcinoma based on biopsy. Definitive surgical resection and histopathology revealed a pleomorphic adenoma, highlighting diagnostic challenges in nasal tumors.
Background
Pleomorphic adenoma is a benign tumor commonly arising in major salivary glands but is rare in the nasal cavity. Nasal pleomorphic adenomas can mimic malignant tumors clinically and histologically due to their high cellularity and limited stromal components. Accurate diagnosis is critical as management involves complete surgical excision with clear margins to prevent recurrence and potential malignant transformation.
Data Highlights
Patient: 71-year-old female with 4-year history of right nasal obstruction and ipsilateral epiphora. Imaging: CT showed near-complete obstruction of right nasal cavity, bulging medial maxillary sinus wall, no bone lysis. Initial biopsy: Differentiated, keratinizing invasive squamous cell carcinoma. Surgical procedure: Endoscopic removal with right maxillectomy and maxillary sinus clearance. Definitive histopathology: Pleomorphic adenoma with mixed epithelial and mesenchymal components, squamous metaplasia without atypia. Follow-up: At 3 and 6 months, no recurrence; resolution of symptoms except persistent nasal asymmetry.
Key Findings
Initial biopsy suggested squamous cell carcinoma, but final diagnosis was pleomorphic adenoma.
Pleomorphic adenoma in the nasal cavity is rare and can mimic malignancy clinically and microscopically.
The tumor was well-encapsulated and attached to the nasal septum, allowing complete surgical excision.
Histopathology showed mixed epithelial and mesenchymal components with squamous metaplasia but no cytologic atypia.
Postoperative follow-up showed symptom resolution and no tumor recurrence at 6 months.
Persistent nasal pyramid asymmetry remained despite successful tumor removal.
Clinical Implications
Clinicians should consider pleomorphic adenoma in the differential diagnosis of nasal masses, especially when biopsy suggests carcinoma but clinical features are atypical. Complete surgical excision with clear margins is essential for both treatment and definitive diagnosis. Long-term follow-up is necessary due to the risk of recurrence and potential malignant transformation.
Conclusion
Nasal pleomorphic adenoma can closely mimic squamous cell carcinoma, leading to diagnostic challenges. Definitive diagnosis requires complete excision and thorough histopathologic evaluation to guide appropriate management and follow-up.
References
Otolaryngology Case Reports -- Nasal Tumor Misdiagnosed as Carcinoma
