Human Pathology: Case Reports 14 (2018) 60–61

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Human Pathology: Case Reports

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Case Report

Oncocytoma of the nasal septum: A rare cause of persistent irritation T

a,⁎ b c
Farid M. , Protts F. , Michael P.
a
Department of Plastic and Reconstructive Surgery, Barts Health NHS, London, United Kingdom
b
Sandwell and West Birmingham NHS Trust, United Kingdom
c
Department of Otolaryngology, Royal Victorian Eye and Ear Hospital, Melbourne, Australia

A B S T R A C T

Oncocytoma is a rare tumour of epithelial tissue. We present a 64 year old woman of Caribbean origin who presented with left sided nasal irritation only. Direct
rhinoscopy confirmed a small nasal septum lesion. This was surgically excised and histologically identified as an oncocytoma. This case highlights the need for
thorough initial assessment and careful histological analysis to detect rare nasal neoplasms.

1. Introduction Histological analysis showed a well-circumscribed lesion with pro-

The term oncocytoma is used to describe a variety of benign neo-
plastic lesions that are identified histologically as being comprised
primarily of oncocytes. Oncocytes are enlarged cells with eosinophilic
granular cytoplasm and vesicular nuclei. This hyperplasia is driven by
mitochondrial DNA deletions resulting in extensive, abnormal pro-
liferation of mitochondria [1–4].
These rare tumours may originate within many different tissues,
including thyroid, kidney and adrenal cortex. Within the head and neck
they are seen within epithelial tissue of the salivary glands. They are
uncommon representing less than 1% of the tumours affecting major
salivary glands. A small number of oncocytomas have been described
affecting the minor salivary glands of the oropharynx, larynx, and nasal
cavity [2,3]. Most oncocytic lesions are benign, however, there are
reported cases of malignant oncocytomas in the salivary glands, pan-
creas, kidney and adrenals [5–9].
2. Case presentation
A 64 year old woman of Caribbean origin presented with a 5 month
history of persistent irritation with itching and discomfort to the left
side of her nose. The patient described no pain, epistaxis or nasal ob-
struction and she was systemically well. Anterior rhinoscopy revealed a
well-defined 5 mm × 7.5 mm lesion anteriorly within the mucosa of the
left side of the nasal septum, which was non-tender with a bluish col-
ouration. The patient underwent primary investigation with excision of
the lesion under local anaesthesic. The surgical margins were found to
be clear and the biopsy site healed well. She was reviewed annually for
2 years, and found to be symptomatically improved with no evidence of
recurrence.
liferation of tubules lined with oncocytic epithelium and central cystic
degeneration (Fig. 1). Hematoxylin and eosin staining showed the cells
to have extensive granular eosinophilic cytoplasm and vesicular nuclei.
Cytological atypia and mitoses were absent and there was no evidence
of infiltration or invasion into surrounding tissues. (Fig. 2).
3. Discussion
The nasal cavity is a rare site for the primary occurrence of onco-
cytoma. Although case reports describe tumours in a variety of loca-
tions in the nasal cavity and sinuses, there are only a few reported cases
of oncocytoma of the nasal septum [5,6,10–16]. Common presenting
symptoms for nasal oncocytomas are epistaxis, nasal obstruction, rhi-
norrhoea, and the sensation of a nasal mass [3,10,12,16]. The main
interesting fact in this case was the unusual presentation without the
typical clinical signs. Oncocytomas usually present late in life, however,
lesions involving the nasal cavity have been described across a wide age
range with a younger average presenting age than major salivary gland
oncocytomas [17].
Oncocytomas of the minor salivary glands are considered more
aggressive with a higher propensity for malignant transformation, than
those of major salivary glands [4,16–20]. Early identification and
treatment in this case may have prevented later symptomatic problems,
such as impact on vision or nasal obstruction.
Management of sinonasal oncocytomas is through resection of the
tumour, this may require endoscopic or open techniques, such as
Caldwell-Luc approach, or a combination of both. In this case the tu-
mour was suitable for resection under direct vision. In cases of malig-
nant transformation use of radiotherapy has been described, although
it's role is not clearly defined [16,17].

⁎
Corresponding author.
E-mail address: m.farid@nhs.net (M. Farid).

https://doi.org/10.1016/j.ehpc.2018.08.004
Received 5 January 2018; Received in revised form 3 August 2018; Accepted 14 August 2018
2214-3300/ © 2018 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/).
M. Farid et al.
Fig. 1. Medium power microscopic view showing proliferation of tubules lined
with oncocytic epithelium and central cystic degeneration.
Fig. 2. High power microscopic view showing large eosinophilic cytoplasm
with a granular pattern and vesicular nuclei together with absence of cytolo-
gical atypia and mitoses.
The recurrence rate for sinonasal space oncocytic tumours is higher
than for those in major salivary glands and may be greater than 50%
where there are features of malignancy, however in the absence of in-
vasion/infiltration and mitotic figures recurrence rates are low
[4,16,17]. Although rare, recurrence of oncocytomas may occur after a
long interval and some cases report recurrence with malignant trans-
formation many years after resection, so long-term follow up may be
advisable [17,19,20].
Oncocytosis may be seen as a feature of a primary oncocytoma, as in
this case, however other differentials must be excluded, including on-
cocytic features as a component of other salivary gland neoplasms such
as pleomorphic adenoma or mucoepidermoid carcinoma, a primary
oncocytic carcinoma or ductal carcinoma or metastatic deposits (e.g.
from a renal cell carcinoma) [3,4]. Pleomorphisms along with the
presence of spindle cells and plasmacytoid myoepithelial cells differ-
entiate pleomorphic adenomas from oncocytomas, and mucoepi-
dermoid carcinoma require demonstration of high intracellular mucin
levels. Primary oncocytic carcinoma would be expected to demon-
strated pleomorphic changes and mitoses with evidence of local inva-
sion and infiltration, whilst metastases from distant carcinoma are
likely to also demonstrate hyperplastic nodules external to the capsule.
Salivary duct carcinoma resembles ductal carcinoma of the breast and
may demonstrate calcification and necrosis.
61
Human Pathology: Case Reports 14 (2018) 60–61
4. Conclusions
The symptom of nasal irritation is often ascribed to rhinitis. This
case illustrates the need for thorough evaluation to exclude coexisting
pathology in presence of an innocuous but persistent symptom. The
finding of an oncocytic lesion arising in the nasal septum requires
careful histological evaluation to rule out rare malignant or invasive
causes. Long term follow up for oncocytomas identified in minor sali-
vary glands is advisable as late recurrence is a recognised phenomenon.
Conflict of interest
None.
Funding
None.
Acknowledgments
None.
References
[1] D.W. Cotton, Oncocytomas, Histopathology 16 (5) (1990) 507–509.
[2] V. Máximo, E. Rios, M. Sobrinho-Simões, Oncocytic lesions of the thyroid, kidney,
salivary glands, adrenal cortex, and parathyroid glands, Int. J. Surg. Pathol. 22 (1)
(2014) 33–36.
[3] W.C. Faquin, C.N. Powers, Oncocytic tumors: oncocytoma, warthin tumor, and
acinic cell carcinoma, in: W.C. Faquin, C.N. Powers (Eds.), Salivary Gland
Cytopathology. Essentials in Cytopathology Series, vol. 5, Springer, Boston, MA,
2008, pp. P131–P158.
[4] M.A. Luna, Salivary glands, in: B.Z. Pilch (Ed.), Head and Neck Surgical Pathology,
Lippincott, Williams and Wilkins, Philadelphia, PA, 2001, pp. 284–349.
[5] T. Abe, A. Murakami, N. Nakajima, T. Inoue, S. Ohde, M. Miwa, et al., Oncocytic
carcinoma of the nasal cavity with widespread lymph node metastases, Auris Nasus
Larynx 34 (3) (2007) 393–396.
[6] D.K. Banerjee, K.R. Korzec, K. Kim, L. Fanelly, Nasopharyngeal oncocytoma,
Otolaryngol. Head Neck Surg. 113 (1) (1995) 136–137.
[7] N.A. Mahmoud, Malignant oncocytoma of the nasal cavity, J. Laryngol. Otol. 93 (7)
(1979) 729–734.
[8] M. Huntrakoon, Oncocytic carcinoma of the pancreas, Cancer 51 (2) (1983)
332–336.
[9] S.K. Lau, L.D. Thompson, Oncocytic lipoadenoma of the salivary gland: a clin-
icopathologic analysis of 7 cases and review of the literature, Head Neck Pathol. 9
(1) (2015) 39–46.
[10] A.L. Hamdan, G. Kahwagi, F. Farhat, A. Tawii, Oncocytoma of the nasal septum: a
rare cause of epistaxis, Otolaryngol. Head Neck Surg. 126 (4) (2002) 440–441.
[11] M.P. Colreavy, E. Sigston, P.D. Lacy, G.S. Balasubramaniam, B.M. Lyons, Post-nasal
space oncocytoma: a different approach to a rare tumour, J. Laryngol. Otol. 115 (1)
(2001) 57–59.
[12] P. Adhikari, R.B. Pradhananga, B.K. Sinha, B. Pradhan, N. Thapa, Oncocytoma of
maxillary sinus–a rare presentation, Nepal. Med. Coll. J. 8 (4) (2006) 292–293.
[13] R. de Bree, R.A. Scheeren, A. Kummer, R.M. Tiwari, Nasolacrimal duct obstruction
caused by an oncocytoma, Rhinology 40 (3) (2002) 165–167.
[14] C.E. Comin, M. Dini, G. Lo Russo, Oncocytoma of the nasal cavity: report of a case
and review of the literature, J. Laryngol. Otol. 111 (7) (1997) 671–673.
[15] M.E. Fons, D. Poetker, P.E. Wakely Jr., Oncocytoma of the nasal cavity: a case
report, Ear Nose Throat J. 92 (3) (2013) E17–E19.
[16] Z. Hodzic, N.R. Rowan, R. Kashiwazaki, T.J. Willson, E.W. Wang, S.E. Lee, A sys-
tematic review of sinonasal oncocytomas and oncocytic carcinomas: diagnosis,
management, and technical considerations, Int. Forum Allergy Rhinol. 7 (5) (2017)
514–524.
[17] Y.W. Hu, C.Z. Lin, W.Y. Li, C.P. Chang, L.W. Wang, Locally advanced oncocytic
carcinoma of the nasal cavity treated with surgery and intensity-modulated radio-
therapy, J. Chin. Med. Assoc. 73 (2010) 166–172.
[18] Suhasini Gotur Palakshappa, Vishal Bansal, Vandana Reddy, Nagaraju Kamarthi,
Oncocytoma of minor salivary gland involving the retromolar region: a rare entity,
J. Oral Maxillofac. Pathol. 18 (1) (2014 Jan) 127–130.
[19] M.A. Cohen, J.G. Batsakis, Oncocytic tumors (oncocytomas) of minor salivary
glands, Arch. Otolaryngol. 88 (1968) 71–73.
[20] M.E. Johns, J.G. Batsakis, C.D. Short, Oncocytic and oncocytoid tumors of the
salivary glands, Laryngoscope 83 (1973) 1940–1952.