Issue: 2015 > December > photo quiz

A relapsing swelling of the nasal tip

F.R. Datema, R.M.L. Poublon, J.A.M. van Laar
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The dermatologist referred a 59-year-old male to the otorhinolaryngology department for further analysis of a progressive, intermittent tingling and swelling of the left nasal tip. His symptoms started one year before without any preceding trauma. Local skin biopsy had revealed signs of rosacea telangiectatica, insufficiently explaining these symptoms. Physical examination showed a solid, subcutaneous swelling with a diameter of 1.5 cm in the area of the left lower lateral cartilage. A more prominent columellar show on the ipsilateral side was suggestive of skin retraction, either secondary to the biopsy or to the lesion (figure 1). Inflammatory parameters and autoimmune markers were normal (WBC, CRP, ESR, p- and cANCA, rheumatoid factor, anti-CCP, ANA and subtypes). To rule out a malignancy causing skin retraction an external rhinoplasty was performed, exposing amorphous irregular cartilage on the vestibular side of the lower lateral cartilage, which was resected (figure 2). Histologically, the cartilage was irregular, covered by fibrous connective tissue and perivascular inflammatory cells.

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