Pleomorphic adenoma originates from inferior nasal turbinate causing epiphora ☆ Bekir Erol a, ⁎, Ömer Tarık Selçuk b , Cemil Gürses a , Üstün Osma b , Mert Köroğlu a , Dinç Süren c a Department of Radiology, Antalya Education and Research Hospital, Antalya, Turkey b Department of Otolaryngology-Head and Neck Surgery, Antalya Education and Research Hospital, Antalya, Turkey c Department of Pathology, Antalya Education and Research Hospital, Antalya, Turkey abstract article info Article history: Received 4 October 2012 Received in revised form 22 November 2012 Accepted 20 December 2012 Keywords: Pleomorphic adenoma Nasal cavity Sonoelastography Endoscopy Pleomorphic adenoma is the most common benign tumor of the salivary glands. A 62-year-old female patient presented with epiphora and was suffering from breathing difficulties. With the diagnostic nasal endoscopy, a mass, originating from right inferior nasal turbinate and filling the entire nasal cavity, was seen. Originating from the inferior nasal turbinate is a very rare entity. Paranasal sinus computed tomography and magnetic resonance images revealed a mass that fills and expands the right nasal cavity. Mass was hypoechoic in B- mode ultrasonography and hypovascular in color Doppler ultrasonography, and rate of tissue stiffness was high in sonoelastography. These were helpful for the diagnosis. © 2013 Elsevier Inc. All rights reserved. 1. Introduction Pleomorphic adenoma (PA) is the most common benign tumor of the salivary glands. PA may occur in the minor salivary glands [1]. However, nasal cavity is very rare [2]. We presented a case of PA of the inferior nasal turbinate with imaging finding. 2. Case report A 62-year-old female patient with a recent complaint of tearing eye was admitted to eye clinic. She was suffering from breathing difficulties from right nasal passage for 4 years that was increased in the last 3 months. The patient consulted to the ear, nose, and throat clinic, and anterior rhinoscopy revealed a mass that was originating from the inferior nasal turbinate and fills the right nasal passage completely. Paranasal sinus computed tomography (CT) detected a sharply circumscribed, slightly lobulated contoured soft tissue mass; 53×32×40 mm in size, completely filling the right nasal cavity (Fig. 1), which was accompanied by loss of the right maxillary sinus aeration. MRI was performed for further evaluation, and a sharply circumscribed homogeneous mass was seen with hypoin- tense and hyperintense signal pattern on T1-weighted MR (magnetic resonance) images and T2-weighted MR images, respectively. Mild heterogeneous enhancement of the tumor was present on axial postgadolinium T1-weighted MR image (Fig. 2). To better assess the internal structure and vascularity of the mass that fills the nasal cavity, B-mode ultrasonography (US) and color Doppler US was performed. Sharply circumscribed homoge- neous hypoechoic mass again demonstrated in B-mode US and with color Doppler US; mass was found to be hypovascular with a few highly resistant thin vascular structures that were deter- mined. With sonoelastography, degree of mass's stiffness was increased compared to the subcutaneous fat tissue and heteroge- neous coded blue and green (Fig. 3). The strain ratio (SR) was measured 39 and 63, respectively. Nasal endoscopy revealed a mass originating from right inferior turbinate and fills the entire nasal cavity during endoscopic biopsy procedure. Multiple biopsies were taken from the mass that was originating from the right inferior nasal turbinate after a mucosal incision performed to the inferior turbinate. Microscopic examination of the tumour revealed a biphasic pattern consisting of epithelial and mesenchymal areas. The epithelial component showed a variety of cell types including cuboidal, basaloid, squamous, sebaceous, and clear cells. The epithelium formed sheets or duct-like structures generally. The ducts contained eosinophilic secretory material and were usually small, but some of them distended to form microcysts (Fig. 4). The ducts showed cuboidal luminal cells and a layer of myoepithelial cells. The appearance of mesenchymal component was chondro- myxoid. The inner ductal cells were positive for pancytokeratin, whereas the neoplastic myoepithelial cells coexpressed pancytoker- atin, vimentin, and S-100 protein. Histopathological diagnosis was compatible with PA. Clinical Imaging 37 (2013) 747–749 ☆ This case report is the authors' own work. It has not received any funding for research. There is no conflict of interest. ⁎ Corresponding author. Department of Radiology, Antalya Education and Research Hospital, 07100, Antalya, Turkey. Tel.: +90 242 249 44 00; fax: +90 242 249 44 62. E-mail address: dr.bekirerol@gmail.com (B. Erol). 0899-7071/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clinimag.2012.12.010 Contents lists available at SciVerse ScienceDirect Clinical Imaging journal homepage: http://www.clinicalimaging.org