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Nasal Chondroma

King Edward Memorial Hospital Bombay, India
University of North Carolina School of Medicine Chapel Hill, NC 27599-7510

Epithelial tumors constitute most of those occurring in the nose or the nasal cavity [1]. Chondrogenic tumors are relatively uncommon, with malignancy occurring twice as frequently as in benign tumors [2]. Histologic differentiation between chondroma and chondrosarcoma, though crucial in deciding treatment options, may be difficult [3]. Chondrogenic tumors of the facial skeleton usually show aggressive behavior. Because of the discrepancy between the histologic picture and biologic behavior, chondrogenic neoplasms should be considered potentially malignant [3]. Because 20% of head and neck chondrosarcomas may be misdiagnosed initially as benign, the treatment of choice is wide surgical excision [1].

A 45-year-old woman presented with gradual onset of bilateral nasal obstruction over a period of 2 months. Clinical examination revealed a nontender gray midline expansile mass in the nasal cavity. The mass was soft and did not bleed. No cervical lymphadenopathy was present. Unenhanced and contrast-enhanced CT of the nasal cavity and paranasal sinuses showed a homogenous soft-tissue midline nasal cavity mass arising from the nasal septum with minimal contrast enhancement (Fig 4A). The mass caused bowing and scalloping of adjacent bones (Fig 4B). No intratumoral calcification, local tissue destruction, or cervical lymphadenopathy was seen. Wide excision of the mass was performed. The histopathologic examination showed hyaline cartilage cells arranged in lobules. No nuclear atypia or hyperchromasia was found. The patient had been asymptomatic for 6 months at this writing with no findings of recurrence of the mass on follow-up CT.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A. —45-year-old woman with bilateral nasal obstruction over period of 2 months. Coronal contrast-enhanced CT scan of paranasal sinuses shows homogenous soft-tissue mass (M) arising from nasal septum.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B. —45-year-old woman with bilateral nasal obstruction over period of 2 months. Axial CT scan reconstructed in bone algorithm of nasal cavity shows soft-tissue mass (M) expanding nasal cavity. Note bowing of nasal septum (small arrow) and medial wall of maxillary sinuses (large arrows). These findings favor slow-growing indolent neoplasm rather than malignant process.

Nasal chondroma is a rare neoplasm. Approximately 60% of tumors occur in patients less than 50 years old [1]. No sex predilection exists. Chondromas arising from the nasal septum are midline. They are usually well circumscribed and appear fairly homogenous on CT. They tend to be expansile lesions that remodel bone [1]. They do not provoke sclerotic bone at their margins. Calcification of the chondroid matrix occurs rarely [1]. The diagnosis of a nasal chondroma is based on the combination of clinical, radiologic, and pathologic findings.

Chondrogenic tumors of the head and neck region are rare and most often malignant. The sites of predilection in the head and neck region include ethmoid sinus (50%), maxilla (18%), nasal septum (17%), hard palate and nasopharynx (including sphenoid sinus) (6% each), and alar cartilage (3%) [2]. These tumors probably arise from remnants of the embryonal cartilaginous skeleton that escape resorption during endochondral ossification [4].

The differential diagnosis of nasal cavity mass lesions is extensive and includes many inflammatory and neoplastic entities. Nasal polyps are the most common expansile lesions in the nasal cavity. They are associated with allergy, vasomotor rhinitis, and inflammation. Most polyps have a mucoid attenuation (10-18 H) on CT [1]. Fungal infections, rhinosporidiosis, tuberculosis, Wegener's granulomatosis, and lethal midline granuloma present as nasal cavity soft-tissue mass lesions with variable bone destruction [1]. The diagnosis of nasal chondroma must be considered in the differential diagnoses of midline nasal cavity masses. Recognition of this entity aids in appropriate treatment.

References

1. Som PM. Sinonasal Cavity. In: Som PM, Bergeron RT, eds. Head and neck imaging, 2nd ed. St. Louis: Mosby, 1991: 114-200
2. Murthy DP, Gupta AC, SenGupta SK, Dutta TK, Pulotu ML. Nasal cartilaginous tumour. J Laryngol Otol 1991;105: 670 -672[Medline]
3. Ruark DS, Schlehaider VK, Shah JP. Chondrosarcomas of the head and neck. World J Surg 1992;16: 1010 -1016[Medline]
4. Fu Y-S, Perzin KH. Non-epithelial tumors of the nasal cavity, paranasal sinuses and nasopharynx: a clinicopathological study. III. Cartilaginous tumors (chondroma, chondrosarcoma). Cancer 1974;4: 453 -463

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This Article Figures Only Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Patanakar, T. Articles by Mukherji, S. K. Search for Related Content PubMed Articles by Patanakar, T. Articles by Mukherji, S. K. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?