Unilateral sino-nasal haemorrhagic polyp masquerading as a malignancy in a boxer

A 32-year-old Polish Caucasian man was referred to the otolaryngology clinic by his general practitioner with a two-month history of right-sided nasal obstruction and epistaxis. The patient was an amateur boxer and had sustained many blows to the nose and face, but could not recall any major recent injuries. He had no symptoms of rhinorrhoea, postnasal drip, hyposmia or facial pain. The patient denied suffering from dysphagia, dysphonia or weight loss. The patientwas hypertensive (blood pressure of 167/95 when checked in the preassessment clinic) but was not on medication for this and was noted to have a high body mass index (35.9 kg/m). He had no previous surgical history, was on no regular medications and had no drug allergies. There was no relevant family history. The patient was an ex-smoker. Flexible nasendoscopic examination revealed a large right-sided nasal mass arising from the right middle meatus with some contact bleeding. Examination of the left nasal cavity, postnasal space and larynx was normal. Therewas no significant septal deviation. Systemic examination was unremarkable. Blood tests revealed a normal haemoglobin, platelet count, clotting and renal function. A non-contrast-enhanced computerized tomography (CT) scan was performed and demonstrated a bulky mass lesion extending from the right maxillary antrum into the right nasal airway (Figure 1). The mass was filling the entire right maxillary antrum (which was expanded) and thinning the lateral nasal wall. No abnormalities were seen on the left side. The patient was subsequently taken to theatre for functional endoscopic sinus surgery. A large polypoid lesion was seen filling all of the maxillary antrum with extension into the right nasal cavity. The lesion was suspicious for a malignancy as the mass had produced a partial automaxillectomy and a very large middle meatal antrostomy. The entire lesion was excised piecemeal (Figure 2) and sent for histology. The left nasal cavity was normal. Histological examination revealed polypoid, inflamed and congested respiratory mucosa together with organizing blood clot. There were associated foamy and haemosiderin laden macrophages but no evidence of malignancy. The conclusion was of an inflammatory nasal polyp with organizing haematoma. The patient was seen in the outpatients department two weeks postsurgery and was well with complete resolution of his symptoms. He was advised to have his blood pressure re-assessed by his general practitioner.