Peripheral Nerve Sheath Tumor of Posterior Nasal Septum: A Case Report

We present a case of a 62-year-old female with an unusual tumor of the posterior nasal septum.

The patient complained of worsening of nasal breathing for the last several years. She is diabetic, with appropriately controlled glycemia with insulin. Routine nasal examination at the onset of symptoms did not show evidence of nasal pathology. She denied epistaxis, headaches, or nasal discharge. Since the nasal obstruction progressed, another ENT exam showed bulging of posterior septum that obstructed both nasal cavities but was covered with normal mucosa. A CT scan showed a round tumor occupying the posterior septum, measuring 4 cm in diameter, located just in front of the sphenoid rostrum.

A preoperative biopsy specimen showed tumor composed of myxomatous stroma and numerous vascular spaces. Stroma contained small fusiform to star-shaped cells without mitotic activity. Initial pathohistological finding suggested “hemangiopericytoma-like” tumor. The tumor was removed endoscopically. Negative margins were confirmed by intraoperative biopsy. Definitive pathohistological and immunohistochemical analysis (Vimentin, CD31, CD34, GFAP, NSE, S100, CK-pan, SMA) due to strong immunoreactivity to S100 protein suggested a definitive diagnosis of peripheral nerve sheath tumor.

A clinical finding of very moderate bleeding during biopsy also supports this diagnosis instead of vascular tumor. Benign peripheral nerve sheath tumors are rare in the head and neck area, with only one case arising in the nasal septum, according to literature cited in Medline.