Angioleiomyoma of the Nasal Tip

We present a rare case of nasal tip angioleiomyoma in a 59-year-old man that adds valuable evidence to the pertinent literature. This represents the first documentation of an exceptionally unusual 20-year natural course of nasal tip angioleiomyoma and identifies a previous trauma as a potential predisposing factor for tumorigenesis. This case enriches the differential diagnostic framework for nasal tip masses and further validates that complete surgical resection is the definitive curative therapy for this condition.

A 59-year-old male patient was referred to the Department of Otorhinolaryngology for evaluation of a nasal tip mass. The lesion presented as a hawk-beak-like deformity of the nasal tip and measured approximately 1.0 cm × 0.8 cm. The clinical examination revealed a locally elevated, mulberry-like surface with telangiectasia, no ulceration, and limited mobility. On palpation, the mass was soft, nontender, and lacked detectable arterial pulsation (Figure 1a). The patient reported a history of bamboo-induced trauma to the nasal tip 20 years earlier, which had not been disinfected or treated with oral anti-inflammatory agents. Since then, the mass had grown progressively without causing local discomfort, chills, or fever. Notably, the lesion had exhibited accelerated growth over the past year.

Laboratory investigations, including complete blood count, were within normal limits. Contrast-enhanced computed tomography revealed an isodense nodular lesion at the nasal tip with marked enhancement postcontrast, suggestive of hypervascularity (Figure 1b). The mass was completely excised under local anesthesia; intraoperative findings confirmed a cystic structure. Histopathological analysis using hematoxylin-eosin staining demonstrated a tumor composed predominantly of well-differentiated smooth muscle cells arranged in fascicular and whorled patterns around vascular lumens, without significant cellular atypia (Figure 1c). These features supported a definitive diagnosis of angioleiomyoma of the nasal tip. Postoperatively, the patient received anti-inflammatory and symptomatic therapy. Follow-up examination 2 weeks after discharge showed satisfactory healing of the nasal tip, with no residual symptoms. We observed no evidence of recurrence or new clinical complaints during a 24-month follow-up period.

Angioleiomyoma arises from smooth muscle cells in the blood vessel walls and is most commonly found in the subcutaneous tissues of the extremities.¹ Nasal involvement is rare, with a higher prevalence of nasal angioleiomyoma reported in females.^2-4 Angioleiomyoma typically exhibits indolent growth over many years; a documented 20-year natural history, as observed in this case, has not been previously described in the literature. While cutaneous and subcutaneous leiomyomas may be densely innervated and associated with paroxysmal pain, lesions in the head and neck region are generally asymptomatic.² The exact etiology of angioleiomyoma remains unclear, although proposed contributing factors include prior trauma, infection, hormonal influences, and vascular malformations.⁵

Complete surgical excision is considered curative, with an extremely low risk of recurrence.⁶ Nevertheless, clinical vigilance is warranted, as delayed diagnosis or inadequate management may lead to increased morbidity and a potential, albeit rare, risk of malignant transformation.^4,7 Written informed consent was obtained from the patient and his family for the publication of this report and accompanying images.

We thank the patient for granting permission to publish this information.