Head and Neck Pathology Slide Seminar: Risk of underdiagnosis and overdiagnosis in head and neck pathology

Case 2: Presented by Alena Skalova, MD Clinical History 35-year-old man presented with a chief complaint of nasal obstruction. Physical examination revealed a glistening mass filling the right posterior choana and the posterior aspect of the right nasal fossa. The patient was admitted to the hospital and intranasal polypectomy was performed. The patient presented with recurrent mass in the nasal cavity 14 months after first surgical resection. The specimen represents recurrent nasal lesion. Histologically, the lesion was characterized by a conspicuous proliferation of variously sized blood vessels. Post-thrombotic changes of the vessels and variously heavy deposition of fibrin in the organizing thrombi were noted. The stroma revealed a heavy inflammatory infiltrate, and it was in places hyalinized. Reactive changes of skeletal bone were also found. Capillary proliferation arranged in a lobular fashion indistinguishable from pyogenic granuloma was seen. Cellular foci of a capillary proliferation with various degree of atypia simulating angiosarcoma were also focally found. Mitoses were rare to absent and atypical mitoses were not present.