Angioleiomyoma of the nasal septum

Navarro Júnior, Carlos Roberto Ribeiro; Fonseca, Adriano Santana; Mattos, José Rodrigo Lordello de; Andrade, Nilvano Alves de

doi:10.1590/S1808-86942010000500027

leiomyoma; nose neoplasms; nasal septum

CASE REPORT

^IMD. Resident Physician in ENT and HNS - Santa Casa de Misericórdia da Bahia

^IIMD. ENT and Maxillo-facial surgeon. Preceptor at the ENT Residency Program - Santa Casa de Misericórdia da Bahia

^IIIMD. ENT and Maxillo-facial surgeon. Preceptor at the ENT Residency Program - Santa Casa de Misericórdia da Bahia

^IVPhD in Surgery - USP, Head of the ENT Residency Program - Santa Casa de Misericórdia de Bahia

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Keywords: leiomyoma, nose neoplasms, nasal septum.

INTRODUCTION

Leiomyoma is a benign smooth muscle tumor, more commonly found in the uterus (95%), skin (3%), nutritional and gastrointestinal tracts (1.5%)¹. It was initially described in the nasal cavity by Maesaka et al. in 1966².

The goal was to describe a case with clinical manifestations and histopathology findings of angioleiomyoma of the nasal septum, a rare benign neoplasia which represents less than 1% of all the leiomyomas in the human body³.

CASE PRESENTATION

M.F.L.S., 62 years, female, African-descendant, she came to our ENT service complaining of a tumor in her left nasal cavity with six years of evolution. In the three initial years it had a progressive growth, associated with low volume epistaxis episodes. After such period, she developed nasal obstruction on the left side and facial pain. Upon physical exam and fibroscopy we noticed a brown, smooth, pedicled lesion on the left-side septum, well outlined, measuring approximately 4 x 2cm, completely occluding the left nasal cavity and pushing the nasal septum. CT scan of the paranasal sinuses showed a well-outlined soft tissue mass, pushing the septum and the lateral wall. Biopsy reported leiomyoma. Later on, the tumor was endoscopically resected, with a 1cm margin, considered adequate according to anatomical and pathological criteria. Microscopy showed polypoid fragments, coated by a single layer of cylindrical hair cells, typical pseudostratified, showing in the stroma, typical leiomyoma bundles around the thick walls of vessels. (Fig. 1)

DISCUSSION AND FINAL REMARKS

This is a slow growth tumor. The most common symptoms are: nasal obstruction, epistaxis, facial pain and headaches. He most frequent treatment for nasal septum angioleiomyoma is endoscopic resection with macroscopic margin, and this was the treatment option for this case - excision with macroscopic and microscopic free margins. Vascular leiomyomas are bundles of smooth muscle cells, relatively organized, and permeated by thick wall vessels⁴.

The nasal septum vascular leiomyoma is an extremely rare tumor, of uncertain origin⁵. Resection is the procedure of choice and it bears a high cure rate. The endoscopic procedure is a good option for small to moderate size tumors⁶.

REFERENCES

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