Pleomorphic Adenoma (Mixed Tumor) of Dorsum of Nose: A Rare Tumor at a Rare Site

Introduction

Pleomorphic adenoma is the most common benign tumor of the salivary glands. 75% of salivary tumors arise from the parotid glands and remaining from the submandibular salivary gland, minor salivary glands, oral cavity and upper aerodigestive tracts. Clinically it is slow growing nodular swelling, histopathology is the main stay in the diagnosis of mixed salivary tumor. Epithelial cells proliferate in strands and some take on a duct like arrangement, other cells are probably of myoepithelial origin and proliferate in sheets. In parts of the tumor, a mucoid material is produced which separates the cells producing a myxomatous appearance and then an appearance resembling cartilage in histological section [1]. The most common site of pleomorphic adenoma of the minor salivary glands, is in the palate followed by lip, buccal mucosa, floor of mouth, tongue, tonsil, retromolar trigone and nasal cavity [6].

Case Report

A 15 year old boy presented with 2 year history of painless swelling over the dorsum of the nose. The swelling is gradually increasing in size to attain the present size. No history of nasal block, nasal discharge, epistaxis. Examination revealed a nodular mass of size 1 × 2 cm on the dorsum of the nose, non tender and mobile. Anterior rhinoscopy revealed no abnormality. Skin over the swelling is healthy. FNAC of the mass showed mixed tumor.

Patient underwent excision of the mass under local anaesthesia and per-operative picture of the mass shown in (Fig. 1). The mass looks like dumbbell shaped and measures 2 × 1 cm (Fig. 2a). The excised mass was sent for histopathological examination. Gross appearance of the incised specimen of the mass revealed, cartilaginous surface. The patient is doing well and no recurrence has been noticed for the past 1 year.

Fig. 1.

Peroperative nasal mass

Fig. 2.

Excised tumor specimen

Histopathological section shows, A fairly circumscribed tumor comprising of ducts lined by epithelial cells, along with keratinous cysts and areas of squamous metaplasia. Stroma shows myxoid change (Fig. 3a, b), features are suggestive of benign mixed tumor.

Fig. 3.

Histopathology of mixed tumor cells

Discussion

Pleomorphic adenoma is the most common tumor of major salivary glands and can also occur in minor salivary glands like palate, nose, cheek, upper lip and external ear. In this case tumor has been located on the dorsum of the nose. Radiological assessment was not done in this case as the mass was superficial and mobile. The first reported case of pleomorphic adenoma of the nasal cavity was in 1929 Jassar et al. [5], Compangno and Wong [3]-reported forty cases of intranasal pleomorphic adenoma and 59 cases by Bat Skis [2].

Conclusion

Pleomorphic adenoma of the dorsum of the nose is very rarely reported, only one case was reported in September 2011 by Irfan Mohamad et al. [4], and hence the case is reported. Preoperative diagnosis is important in unusual sites. The tumor needs total excision.

Conflict of interest

None.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent has been obtained from all individual participants included in the study.