Nasal Septal Ancient Schwannoma: Ancient and Rare.

Schwannoma is a rare benign neurogenic tumor arising from the Schwann cells of peripheral nerves. A 77-year-old man presented with progressively worsening left nasal block and hyposmia for the past six months. Nasal endoscopy revealed a polypoidal reddish mass occupying the left middle meatus. The biopsy was in favor of ancient schwannoma. Endoscopic transnasal excision of the mass arising from the left nasal septum was performed. A middle meatal antrostomy was also performed. The tumor cells were positive for S100 protein. Presenting symptoms are common to other sinonasal tumors, and the differential diagnoses include carcinoma, inverted papilloma, sarcoma, lymphoma, and neurofibroma. Schwannomas are composed of spindle cells with two histologically distinct patterns that can be mixed: Antoni type A and Antoni type B. A neural crest marker antigen, S-100 protein, is useful to corroborate our diagnosis. It is vital to consider nasal septal schwannoma in the differential diagnosis of patients complaining of unilateral nasal obstruction with polypoidal nasal mass, especially the posterior third of the nasal septum. Transnasal endoscopic surgery is the preferred approach for nasal septal schwannoma.

Silent Killer in the Nose: Two Cases of Nasal Alveolar Rhabdomyosarcoma in Adults.

We report two cases of nasal alveolar rhabdomyosarcoma (ARMS) in adult patients from our center who presented with local mass effect and systemic involvement. Our first patient had spontaneous unilateral epistaxis. Her blood investigation showed severe thrombocytopenia, and the bone marrow biopsy result showed bone marrow infiltration by non-hematopoietic malignant cells. Nasal endoscopy showed a mass arising medial to the left middle turbinate. Our second patient presented with right eye proptosis, associated with blurring of vision. Nasal endoscopy showed a right whitish nasal mass arising lateral to the middle turbinate. Both patients were diagnosed by immunohistochemical analysis showing ARMS, a soft tissue malignancy uncommon in adults. RMS in adults has a worse prognosis. Hence, the management is challenging. Early diagnostic workup is essential for the commencement of early treatment for better oncological outcomes.