Nasal Septum Glomus Tumor: A Rare Cause of Unilateral Nasal Obstruction

Glomus tumors or glomangiomas are rare neoplasms arising from the glomus body, which is a perivascular temperature regulating structure. They are primarily cutaneous, mainly found in the subungual region of young adults, but they may occur anywhere. Nasal glomus tumors are extremely uncommon and they manifest with symptoms such as stuffiness, rhinorrhea, epistaxis, and pain. We present a case of nasal glomus tumor, arising from the nasal septum, that was surgically removed with no evidence of recurrence at 21 months of follow-up. Case Presentation: A 73-year-old woman presented at our Ear, Nose, and Throat (ENT) Department, complaining right-sided nasal obstruction combined with intermittent intense pain for the last 2 years. She also reported a sensation of slowly growing mass just inside her right nostril that tended to bleed when touched. She did not mention any other symptoms such as headache, nasal discharge, or hypoesthesia. She reported a history of hypertension, totally controlled with medications, a previous colon cancer surgery, and a breast lump removal. She denied tobacco use. For the past 2 months, she had been treated with local and systemic antistaphylococcal antibiotics, as nasal vestibulitis was the primary diagnosis, without, however, any signs of improvement.The clinical examination showed a healthy but overweight woman. Anterior rhinoscopy on the right side revealed a well-defined tumor arising from the mucosa of the superior part of the caudal end of the nasal septum, 5 to 10 mm in diameter. The mass covered the area of the internal nasal valve and was reddish and friable, without stigmata of hemorrhage osterior rhinoscopy demonstrated no other nasal pathology. The external nose was normal too. A full ENT examination did not show any pathological findings. Routine blood tests were also normal. The patient underwent a biopsy under local anesthesia. In order to take the decision for the type of anesthesia, we took under consideration the patient’s preference and the fact that the mass was easily accessible. Three biopsy samples were taken without significant intraoperative bleeding. The right anterior nasal cavity was packed for a couple of hours postoperatively. Histopathology and immunochemistry findings were consistent with a glomus tumor. Specifically, the tumor cells were round and regular with uniform circular nuclei. Degenerative changes might sometimes be noted in the nuclei Solid areas with an organoid growth pattern could be seen while myxoid stroma could be seen in some areas Variably sized vessels surrounded by collars of glomus cells in a hyalinized stroma were also noted Discussion: Glomus tumors or glomangiomas are benign neoplasms of the glomus body mainly found on the digits, under the nails and they are rarely located in the head and neck area.Epidemiological data demonstrate that most cases have been reported in older population with a mean age of 54 years.4 Females are twice as likely to develop these tumors comparing with males.The first complete clinical description was given by Mason in 1924, while the first nasal glomus tumor was reported in 1965.The classic triad of symptoms includes pain, tenderness, and cold intolerance.7 Glomus tumors may occur as small, painful nasal nodules, which cause nasal obstruction and epistaxis. Macroscopically they appear as reddish, stiff nodules, mainly in the Kiesselbach area, resembling hemangioma or hemangiopericytoma

Author(s): Bruce Adams

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