Sinonasal Ieiomyomas

Abstract

Leiomyomas are common bengin myogenic tumors that are characteristically found in the uterus or gastrointestinal tract. Although they may occur at any site where smooth muscle is present, origin outside of the abdomen is extremely uncommon. There have been 17 reported cases of leiomyomas in the sinonasal region since 1966. 1 . 16 Two cases were reported to have originated in the paranasal sinuses.':" Two additional patients with nasal leiomyomas who have been treated at the Cleveland Clinic Foundation since 1989 are presented with a discussion of the clinical manifestations, histopathologic features, differential diagnosis, and treatment of this unusual neoplasm. CASE REPORTSCase 1. A 43-year-old woman came to the outpatient office with a 2-year history of chronic bilateral nasal obstruction, clear postnasal discharge, and intermittent right-sided epistaxis. Examination with a O-degree rigid nasal endoscope after topical vasoconstriction revealed bilateral inferior turbinate hypertrophy with a normal septum. No evidence was found of mucosal edema, polypoid masses, or purulent nasal secretions. A small "granulation-appearing" mass arose just superior to the anterior attachment of the right inferior turhinate. The mass was removed completely in the office with the patient under local anesthesia. The tumor measured 0.5 x 0.5 x 0.3 em. Hematoxylin and eosin staining revealed multiple thin-walled vascular structures in a hackground of spindle cells. Immunohistochemistry for muscle-specific actin was positive. Pathology was reported as a vascular leiomyoma. From the Departments of Otolaryngology and Communicative Disorders (Drs. Trott, Lavcrtu, and Wood) and Anatomic Pathology (Drs. Gewirtz and Sebek.) the Cleveland Clinic Foundation.