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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 87-89

Chondroma of the nose


1 Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha “O” Anusandhan University (Deemed to be), Bhubaneswar, Odisha, India
2 Department of Medical Research Laboratory, Medical Research Laboratory, IMS and SUM Hospital, Siksha “O” Anusandhan University (Deemed to be), Bhubaneswar, Odisha, India

Date of Submission10-Jun-2019
Date of Acceptance08-Mar-2020
Date of Web Publication22-May-2020

Correspondence Address:
Dr. Santosh Kumar Swain
Department of Otorhinolaryngology, IMS and Sum Hospital, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_36_19

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  Abstract 


Chondromas of the head-and-neck area are rare lesions and more rare over the nose. Chondroma is a benign neoplasm of cartilaginous origin. It is rarely seen over the dorsum of the nose. It causes cosmetic deformity of the nose and face if it arises from the nose. The diagnosis is confirmed by histopathological examination. The treatment is complete surgical excision. We report a case of chondroma arising at the dorsum of the nose which is slightly mobile. Computed tomography scan showed a mild enhancing lesion at the dorsum of the nose which was completely excised via transcolumellar route. Considering its rarity at the dorsum over the nose, we reported this solitary chondroma of the nose. Chondromas have to be kept in mind during evaluation of any mass over the nasal dorsum.

Keywords: Chondroma, dorsum of nose, nose, transcolumellar approach


How to cite this article:
Swain SK, Mohanty JN. Chondroma of the nose. Libyan J Med Sci 2020;4:87-9

How to cite this URL:
Swain SK, Mohanty JN. Chondroma of the nose. Libyan J Med Sci [serial online] 2020 [cited 2020 Jun 6];4:87-9. Available from: http://www.ljmsonline.com/text.asp?2020/4/2/87/284689




  Introduction Top


Chondromas are benign neoplasms composed of mature hyaline cartilage.[1] A nasal chondroma is an infrequent clinical entity. Cartilaginous tumor or chondroma is rare in the head-and-neck region. Chondroma is an extremely rare lesion in the maxillofacial region. It is a benign tumor of cartilaginous origin and causes a cosmetic problem for the face. It is a slow-growing neoplasm and sometimes leads to nasal obstruction. Chondroma is a benign tumor, consists of mature hyaline cartilage. In the head-and-neck area, it is seen in the paranasal sinus, larynx, and rarely seen in the nasal structure. In the nose and paranasal sinuses, 50% of cases of chondroma are seen in ethmoids and only 17% are seen in the posterior edge of the nasal septum.[2] The histopathological examination is required for confirmation of diagnosis. Treatment of chondroma is surgical excision, and the chance of recurrence is probably due to an incomplete removal. Considering the rarity of the disease in the nasal dorsum, we report this solitary chondroma in an adult male, which was excised by an open rhinoplasty approach.


  Case Report Top


A 32-year-old male presented with progressive swelling over the dorsum of the nose for 6 months. He was upset for painless nasal hump which appears cosmetically bad. There was no history of frontal headache, nasal discharge, or nasal bleeding. Anterior rhinoscopy revealed normal nasal cavity and nasopharynx. The mass was slightly mobile over the dorsum of the nose and was nontender, smooth, and firm to hard in consistency. The size of the mass was approximately 2.5 cm × 1.5 cm [Figure 1]. He had no palpable neck lymph nodes. Computed tomography (CT) of the nose and paranasal sinuses showed a minimally enhancing homogeneous mass over the dorsum of the nose. There was no intratumor calcification or local tissue destruction. A surgery was planned under general anesthesia where transcolumellar incision was made and a cartilaginous mass [Figure 2] removed. The mass had no clear attachment to any bony cartilaginous structures of the nasal vault. After resection of the mass, the deformity of the nose disappeared and appeared normal cosmetically. The gross pathological examinations of the mass showed a smooth, slippery whitish mass of size 2.5 cm × 1.5 cm and firm in consistency [Figure 3]. The histopathological examination showed benign lesion consists of fibrous tissue and vessels with lacunae containing benign chondrocytes, consistent with chondroma [Figure 4]. The patient was asymptomatic for 12-months of follow-up with no evidence of recurrence [Figure 5].
Figure 1: Appearance of nose before surgery

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Figure 2: Tumour on removal via open rhinoplasty approach

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Figure 3: Gross appearance of the tumor mass after removal from the nose

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Figure 4: Microphotograph showing the histopathological picture of chondroma

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Figure 5: (a and b) Postoperative picture of the nose

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  Discussion Top


Chondromas are benign neoplasms with well-defined boundaries, consists of mature hyaline cartilage tissue. In the head-and-neck region, only 10% of chondromas are seen, and most of these are seen in the larynx and sphenoethmoidal region.[3] Chondromas may arise from the bones or soft tissues. The parts of the head-and-neck area which develop chondroma are nasal cartilage, cervical vertebra, paranasal sinuses, soft palate, nasopharynx, tongue,  Eustachian tube More Details, gingiva, cheeks and buccal mucosa, and larynx.[4] The chondromas of the nose may originate from the paranasal sinuses, nasal bone, nasal septum, and rarely from the alar cartilages. In one study, most of the nasal chondromas originate from the posterior part of the nasal septum.[5] The most widely accepted theory for the origin of chondromas is “embryonic remnants theory,” where during enchondroma ossification phase, few embryonic cartilage cells are not resorbed and later lead to the formation of chondromas.[6] The way by which cartilaginous neoplasms originating at some sites in the head-and-neck region is often puzzling. The cartilaginous tumors like chondroma may originate from the nose and the larynx because of their intrinsic cartilaginous nature. Cartilaginous tumors like chondroma may also arise from bones which ossify in cartilage-like sphenoid and nasal bones. These bones can also harbor cartilaginous rests after completion of ossification. Chondromas and chondrosarcomas may develop in tissues which do not normally possess cartilage at any stage of development. Multidirectional differentiation of the mesenchymal cells is implicated in the origin of this tumors at different sites.[7] The common sites of the head-and-neck region affected by chondroma are the ethmoid sinus (50%), maxilla (18%), nasal septum (17%), hard palate, sphenoid sinus (6%), nasopharynx (6%), and alar cartilage (3%).[8] The chondromas at the nose are extremely rare. Chondromas are benign lesions and slow-growing neoplasms, which remain asymptomatic for a long period in majority cases. It consists of mature hyaline cartilage. Chondromas do not present with pain and usually diagnosed incidentally. The clinical presentations of the nasal chondroma present with nasal obstruction, nasal bleeding, and headache. If chondromas are seen near the skull base area, it may invade into the adjacent structures like optic nerve, internal carotid artery, and other cranial nerves and gives symptoms as per structure involved.[9] The diagnosis of the chondroma over the dorsum of the nose can be considered as differential diagnoses of the midline mass of the nose. The diagnosis is confirmed by biopsy and histopathological examination.[7] Imaging is an important tool for evaluating the bony and soft-tissue characteristics of neoplasm like chondroma. CT scan of the nose and paranasal sinuses with contrast is helpful for assessing the extent of the chondroma. Chondromas are not radio-opaque and appear as well-circumscribed and fairly homogeneous.[10] The diagnosis of the chondroma on the dorsum of the nose is based on the combination of clinical, radiological, and histopathological findings. When a diagnosis is doubtful, magnetic resonance imaging can be done where chondroma shows higher signal intensity on T2-weighted image.[11]

The treatment of the choice is complete surgical excision.[12] In case of large chondroma of the nose, lateral rhinotomy is preferred. For small lesions, the endoscopic approach is a safe and effective method without any complications.[13] Chondroma is radioresistant and it is of little value in case of benign tumors. Radiotherapy is useful in primary and recurrent malignant cartilaginous tumors. Long-term follow-up is needed in this lesion as there is a possibility of the sarcomatous malignant transformation that may occur. The prognosis of the chondroma in the nose is often good, and recurrence is rare with appropriate treatment.[14] In this case, complete surgical excision gave excellent outcomes. The patient is regular follow-up without any recurrence.


  Conclusion Top


Chondroma of the external nasal pyramid is an extremely rare clinical entity. It should be kept in mind while examining a mass over the nose. Histopathological examination is confirmatory for the diagnosis. Complete excision is the treatment of the choice, whereas its recurrence and sometimes transformation into sarcomatous changes should be kept in mind during the treatment course. Close follow up therefore is essential for this tumor. The clinician should consider chondroma as a differential diagnosis in case of any firm mass over the dorsum of the nose.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Quevedo FC, Quevedo FB, Neto JC, Ferreira EN, Carraro DM, Soares FA. Case report: Chondrosarcoma of the head and neck. Hum Pathol Case Rep 2017;7:4-7.  Back to cited text no. 1
    
2.
Murthy DP, Gupta AC, SenGupta SK, Dutta TK, Pulotu ML. Nasal cartilaginous tumour. J Laryngol Otol 1991;105:670-2.  Back to cited text no. 2
    
3.
Jones HM. Cartilaginous tumours of the head and neck. J Laryngol Otol 1973;87:135-51.  Back to cited text no. 3
    
4.
Douglas R, Gnepp MD, editors. Bone lesions. In: Diagnostic Surgical Pathology of the Head and Neck. 2nd ed. Philadelphia: Saunders Elsevier; 2009. p. 742.  Back to cited text no. 4
    
5.
Rivas Lacarte MP, Perelló Scherdel E, Novell V. Solitary chondroma of the nasal septum. An Otorrinolaringol Ibero Am 1996;23:431-4.  Back to cited text no. 5
    
6.
Chien CY, Tai CF, Ho KY, Lee KW, Kuo WR, Wang LF. Nasal septum chondroma: A case report. Kaohsiung J Med Sci 2005;21:142-5.  Back to cited text no. 6
    
7.
Sreedharan S, Kamath MP, Hegde MC, Sundar S, Lobo FD, Raju PK. Chondroma of the nasal bone: A case report. Ear Nose Throat J 2006;85:44-6.  Back to cited text no. 7
    
8.
Rahman MZ, Shaifuddin AK, Shahnaz A, Ghosh PK. Chondroma of the nasal septum-A case report and review of literature. Paki J Otolaryngol 2012;28:97-9.  Back to cited text no. 8
    
9.
Higashida T, Sakata K, Kanno H, Tanabe Y, Kawasaki T, Yamamoto I. Intracranial chondroma arising from the skull base: Two case reports featuring the image findings for differential diagnosis. No Shinkei Geka 2007;35:495-501.  Back to cited text no. 9
    
10.
Kilby D, Ambegaokar AG. The nasal chondroma. 2 case reports and a survey of the literature. J Laryngol Otol 1977;91:415-26.  Back to cited text no. 10
    
11.
Ruark DS, Schlehaider VK, Shah JP. Chondrosarcomas of the head and neck. World J Head and Neck Surg 2002;16:1010-16.  Back to cited text no. 11
    
12.
Scierski W, Namysłowski G, Misiołek M, Widziszowska A, Hajduk A. Septal nasal chondroma – A case report. Otolaryngol Pol 2007;61:1021-3.  Back to cited text no. 12
    
13.
Nemade SV, Qadri H, Sayyed M, Naik CS. Chondroma of nasal alar cartilage: A rare entity. Online J Otolaryngol 2015;5:110.  Back to cited text no. 13
    
14.
Kamath P, Shrinath D, Shetty K, Shetty A, Mathias M, Rent N. A rare case of chondroma of cartilaginous nasal septum. Nitte Univ J Health Sci 2014;4:120-22.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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