Week 284: Case 4

1. Presented by Peter Illei, M.D. and prepared by Danielle Wehle, M.D.

The patient is a 41 year-old African American woman with a right nasal cavity/ orbital mass and proptosis. She presnted with a 5 day history of nasal bleeding that came from the right side and for which she was seen in the emergency room and cautery was performed. However, the bleeding did not subside. The patient also experienced nasal congestion, facial pain and pressure especially around the eye. In addition, the patient is blind in the other eye and has a history of migraine headaches. The present pain she is different from her usual migraines. She has very significant environmental allergies that she was never treated for. She does not have asthma and she denies any history of ability to clot when she has a skin injury. On examination, blood is visible on the right nasal vestibules. A CT scan shows a mass in the interior right nasal cavity that is a budding or encroaching the orbit. The margin of this lesion appears smooth and do not seem to enter into orbital structures. Endoscopy revealed a mucosal covered lesion inferior to the middle turbinate . A biopsy of this lesion was performed and can be seen on the photomicrographs below.