Lipoma of the Nasal Septum: A Case Report

INTRODUCTION

Lipoma is the most common soft tissue neoplasm in adults. It appears mostly in 40–50 years of age and is slightly more prevalent in males than in females. It accounts for differential diagnosis of nasopharynx mass as benign that is located more in upper back, shoulders, arms, buttocks, and upper thigh.¹ The prevalence of this painless tumor is 1% in general population, they are not common in the midface, and it is hard to find and rare in paranasal sinuses or nasal cavity due to scarce amount of fatty tissue.² Here, we report a rare case of nasal lipoma that is found on the nasal septum.

Case DESCRIPTION

A 22-year-old male presented to our hospital with left-sided nasal obstruction for more than 2 years. Patient’s medical history including previous history of allergy or surgery was nonspecific. On physical examination, left-sided septal bulging, which was soft and compressible, was observed (Fig. 1). More careful inspection of upper part of septum revealed a distinct small round mass (Fig. 2). Computed tomography (CT) scan without contrast revealed a hypodense mass with 1.5 cm thickness (Fig. 3). Further evaluation with magnetic resonance imaging (MRI) to inspect any possible intracranial connection showed an amorphous heterogeneous 54 × 8 × 94 mm mass located in the left anterior part of the nasal septum. The mass was hyper signal in T2-weighted images and did not enhance after gadolinium injection, contrary to its overlying normal nasal mucosa (Figs 4 and 5). Under general anesthesia, mucoperichondrial flap was elevated using left hemitransfixion incision, and the tumor was excised completely. Histopathology report confirmed lipoma. Patient had no complications during or after surgery. We followed up the patient for 6 months. His nasal obstruction improved significantly, and the apparent nasal deviation was alleviated to some degree. No recurrence of the tumor was detected in the follow-up period.

DISCUSSION

Lipoma is a benign slow-growing neoplasm that mostly consists of mature adapoid cells. In all, 13% of lipomas occur in head and neck in the posterior neck, chicks, tongue, floor of the mouth, and buccal sulcus.^3,4 Lipoma of the nasal cavity is a rare one that is mostly reported in children as a single mass or a piece of a syndrome.^5–7 There are few reports of lipomas in different parts of nose including nasopharynx, vestibule, nasal dorsum, and inferior turbinate.^4,8–11 Patients may be asymptomatic or like other masses occurring in sinuses and nasal cavity they may present with symptoms, including nasal obstruction, facial edema, tenderness, rupture, and hemorrhage.^8,12–16

There have been reports of pediatric nasal lipoma and their associations with midline fascial defects and different syndromes.¹⁷ Pai syndrome has been described primarily in 1987 as a condition consisting of congenital nasal lipoma, midline cleft of upper lip, skin and nasal polyps and lipoma of central nervous system.^6,18 Other reports indicated the nonsyndromic association of nasal lipoma and intracranial lipoma, especially in corpus callusum.¹⁴ In adults, however, the first case of nasal septal lipoma has been reported in 2000 in a 21-year-old woman referring with unilateral nasal obstruction and posterior septal soft tissue mass.⁴

CT scan can reveal a hemogeneous mostly not encapsulated low-density mass, facilitating the diagnosis by showing the characteristics of fat tissue.¹⁹ It can also help in finding the possible intracranial extension and boney midline defect of face and skull base. Some authors suggested using routine imaging in all cases of pediatric midline nasal lipomas.⁵

In our study, nasal septal lipoma was reported in a 22-year-old man. Tumor removal was done using mucoperichondrial flap. Differential diagnoses of nasal lipoma are dermoid cysts, teratoma, glioma, encephalocele, and meningomyelocele, all of them may resemble a deviation if the septum is examined in less than a meticulous way.¹⁷

CONCLUSION

Lipoma of the nasal septum is a rare presentation. We report a case of nasal septal lipoma with nasal obstruction that could easily pass as a septal deviation without a conscientious examination. Performing imaging studies before septoplasty in cases of nasal obstruction with questionable physical examination could lead to precise diagnosis.

CLINICAL SIGNIFICANCE

Lipoma of nasal septum is not common in the midface, and it is hard to find and rare in nasal cavity due to scarce amount of fatty tissue that presents with nasal obstruction.

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