Volume 7, Issue 6, June – 2022 International Journal of Innovative Science and Research Technology ISSN No:-2456-2165 IJISRT22JUN370 www.ijisrt.com 26 Endoscopic Management of Intranasal Pleomorphic Adenoma: A Case Report Siti Nursiah, Andrina Y.M. Rambe, Irnanda W.R. Nasution Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, University of North Sumatra, Medan 20155, Indonesia Abstract:- Pleomorphic adenoma is one kind of tumor which is the most common benign tumor of major salivary gland tumors. And can occur in the minor salivary gland tissue that can be found in the nasal cavity. Intranasal pleomorphic adenomas are usually formed by the mucous glands of the nasal septum. We found the pathology result of endoscopic surgery. The purpose of this study was to demonstrate an endoscopic approach to surgery for pleomorphic adenoma of the nasal septum. A 34-year-old woman presented with complaints of nasal congestion and occasional bleeding for at least 3 years. We provide treatment with endoscopic surgery to remove the tumor. In this case we ressected the tumor and also the submucous part of the nasal septal to reach tumor-free margins. Microscopic examination shows epithelial tissue, mesenchymal composed of myxoid stroma and also myoepithelial component with H&E staining. The postoperative follow-up of the patient was good, and there were no complications found in the patient. Benign nasal tumors of the minor salivary glands or benign pleomorphic adenomas of the nose are rare tumors and should be considered in their management. A correct histological diagnosis can be confirmed. Treatment for this disease can be done endoscopically endonasal surgery. Keywords:- pleomorphic adenoma, histopathology, nasal septum, endoscopic surgery. I. INTRODUCTION Pleomorphic adenoma is a benign tumor of the major salivary glands that is very frequent. Minor salivary glands in the nasal cavity, hypopharynx, and glands of the larynx or trachea can also be affected. Nonetheless, intranasal pleomorphic adenoma, particularly septal pleomorphic adenoma, is uncommon. Although most salivary glands are found in the lateral wall of the nose and concha, intranasal pleomorphic adenoma mainly arises from glands of the nasal septum mucosa. 1 Salivary gland tumors account for 3% approximately of all head and neck cancers. The benign mixed tumor of salivary glands, also known as Pleomorphic adenoma, occurs primarily in the major salivary glands, particularly 70 % from the parotid gland, and less frequently 15-25 % in the submandibular salivary glands and sublingual salivary glands, because of morphological differences with parts of the epithelial and mesenchymal components. Only about 8% until 10% of Pleomorphic adenoma arise from the small salivary glands. From the soft palate, hard palate, lip, lacrimal gland, also external auditory canal, there have been a few cases documented. 2 The tumor's pathophysiology is yet uncertain. The cause of nasal septal pleomorphic adenoma can be attributed to faulty embryonic ectoderm cell sites, remnants of the vomeronasal organs, possibly triggered by some viral infection, according to some theories. Intranasal pleomorphic adenomas differ from other salivary gland, pleomorphic adenomas in minor salivary gland as they contain a higher cellularity and an epithelial tissue with a low stromal component. This tumor also does not have a capsule. Intranasal Pleomorphic Adenoma is an essential differential diagnosis entity despite its rarity in this site. Nasal congestion and nasal bleeding are the predominant symptoms, which are not typical. It is necessary to conclude the component of epithelial parts paired with mesenchymal for the histological diagnosis about a mixed tumor. The preferred treatment of this tumor is surgical resection. 2 II. CASE REPORT A 34-year-old woman, presented with main complaint of nasal obstruction since 3 years ago which is getting worse over time. The patient also had history of rhinorea mixed with blood and nasal finger picking. During ENT routine examination, found ears were normal, anterior rhinoscopy showed of the right nasal cavity was found mass covering the nasal cavity, pale color and hypervascular, inferior turbinates were difficult to examine, the nasal septum was not deviated, the left nasal cavity was normal. The oropharynx was normal. The CT scan of the paranasal sinus with contrast and the result was found anterior septum mass, homogenous lesion with soft density in the right nasal and the paranasal sinus were normal. Fig 1 CT / Computerized Tomography scan of the paranasal sinus with contrast and the result was found anterior septum mass, homogenous lesion with soft density in the right nasal