Sclerosing Polycystic Adenosis of the Nasal Septum: The Risk of Misdiagnosis
A 49-year-old man presented with a 1-year history of right nasal obstruction and occasional epistaxis. His general health was satisfactory and there was no history of nasal surgery. Nasal endoscopy revealed a 1.5×2 cm mass in the right nasal cavity. The mass was pedunculated, red, and had an irregular surface. The mass arose from the right nasal septum and bled easily on touch (). A computed tomographic scan of the paranasal sinuses showed a polypoidal mass with attachment to the bony nasal septum without erosion into the surrounding structures (). The differential diagnosis included a hemangioma and a minor salivary tumor. A preoperative punch biopsy of the mass suggested the diagnosis of SPA. The lesion was completely excised under endoscopic endonasal surgery under general anesthesia. A margin of normal mucosa and the underlying perichondrium was widely excised.\nGrossly, the tumor was a firm pedunculated mass, measuring 2.1×1.5×1.1 cm, with a peduncle 4 mm in length. The cut surface was lobular and glistening, containing a few tiny visible cysts <1 mm in diameter. The microscopic examination revealed a subtle lobular proliferation of dilated ductal components with cystic changes surrounded by abundant dense hyalinized hypocellular collagen stroma with a mild inflammatory cell infiltration. The ductal epithelial cells were flattened and cuboidal without atypical features. Frequent apocrine metaplasia was noted (). Immunohistochemical staining for α-smooth muscle actin demonstrated myoepithelial cells surrounding ductal epithelium and the epithelial cells lining ducts showed focal immunoreactivity for estrogen receptor (). Together, these findings were characteristic histopathologic features of SPA. The patient was discharged the next day, and the postoperative course was uneventful.\nPostoperatively, no wound complications were observed and no recurrence was observed at the 12-month follow-up examination.