Fibroepithelial Polyp Arising From the Nasal Vestibule

A 63-year-old man presenting with a 1-year history of right-sided nasal obstruction and intermittent epistaxis was referred to the Department of Otolaryngology of our university hospital. Nasal endoscopy demonstrated a lobular mass which filled the right vestibule. This pedunculated mass was broadly attached to the right vestibule (Figure 1 A). Computed tomography scan of the sinus revealed a soft tissue opacity that filled the right nasal vestibule without any signs of sinus invasion and bone destruction. The patient denied any history of underlying systemic disease, bleeding disorders, relevant facial trauma, or nasal surgery.

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Figure 1.

A, Nasal endoscopy shows a lobular mass that has filled the right vestibule. This pedunculated mass is attached to the right vestibule broadly. B, The mass is cauterized at its base and completely excised.

The mass was endoscopically excised under local anesthesia. After the right nasal vestibule was retracted, the mass was cauterized at its base and completely excised (Figure 1 B). Pathological examination of the excised mass confirmed the diagnosis of a fibroepithelial polyp. Fibrovascular cores were composed of loose collagen with increased blood vessels and covered by squamous epithelium (Figure 2). The patient’s nasal breathing improved immediately after surgery. Endoscopy outcomes were normal 3 months after operation.

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Figure 2.

Pathological examination reveals that the fibrovascular cores (arrow) are composed of loose collagen with an increased network of blood vessels and is covered by squamous epithelium (arrowhead), compatible with a fibroepithelial polyp (H&E stain, ×40).

Fibroepithelial polyps are benign polypoid lesions that originate from the mesodermal tissue and are composed of varying amounts of stroma covered by squamous epithelium. ¹ They are also known as fibromas or acrochordons and present with a nonspecific and benign growth pattern. They are typically observed in the skin and the lower respiratory, gastrointestinal, and genitourinary tract; however, their presence is rarely noted in the nasal cavity. There are a few extremely rare cases which demonstrate the presence of a fibroepithelial polyp in the nasal turbinates. ^2,3 The fibroepithelial polyps of the nasal cavity may cause nasal obstruction while breathing.

As these lesions are considered to arise through a nonspecific, benign growth pattern, it may be difficult to characterize their etiology. Studies have proposed chronic inflammation from irritation or infection, hormonal imbalances, and developmental defects. Traditionally, fibroepithelial polyps have been thought to occur after mucosal trauma. ² In our case, there was no history of mucosal irritation.

Although fibroepithelial polyps are benign, slow-growing tumors, they need to be excised and examined histopathologically because of the possibility of tissue metaplasia and the extremely low incidence of malignant transformation. ⁴ To the best of our knowledge, this study is possibly the first described case of a fibroepithelial polyp originating from the nasal vestibule.