A lump on the nose.

To cite: Verkerk M, Powell J, Wilson J. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015211806 DESCRIPTION A young woman presented with prominence of the dorsum of her nose since childhood. She had become increasingly self-conscious of her appearance but was otherwise fit and well. She denied symptoms of nasal obstruction, epistaxis or discharge but described an intermittent ache related to the lump. There was no history of seizures, meningitis or cerebral abscess. Examination revealed a firm midline dorsal hump (figures 1 and 2). The rest of the examination was normal. Nasal surgery was delayed into adulthood as not to impede nasal development. At the age of 19 years she underwent open septorhinoplasty for correction of what was thought to be a congenital osseocartilagenous deformity. A skin-coloured, fibrous mass of adipose tissue, skeletal muscle and nerve fibres was resected. This was histologically confirmed to be a subcutaneous hamartoma. Hamartomas are benign tumours that represent the anomalous development of multiple tissue types native to the organ in which they are found. Most hamartomas are solitary, however multiple hamartomas may suggest tuberous sclerosis (associated with epilepsy), Cowden syndrome (macrocephaly, intestinal polyps, cutaneous hamartomas and increased cancer risk) or Proteus syndrome (overgrowth of skin, bones and other tissues).