Spindle Cell Neoplasm of Bridge of Nose

Abstract

Introduction: Spindle cells are a feature of many benign and malignant mesenchymal tumors. Differentiating benign versus malignant tumors is based on the presence and type of extracellular matrix, the nuclear and cytoplasmic features of the spindle cells, and the presence of mitoses and necrosis. In bone tumors, the imaging is often predictive. Fibrous histiocytoma is a benign tumor of mesenchymal origin.¹ The tumor frequently appears in sun exposed areas on skin and orbital tissues.² The subcutaneous appearance of this tumor in deep soft tissues is rare. It is usually not life-threatening, though it can be aggressive causing serious complications. However, bridge of nose is a very uncommon area for the origin of spindle cell tumour.

Case Report: A 40-year-old woman presented with painful swelling at the left side of bridge of nose and lacrimation from left eye for 4 months. It was  oval and hard 2cm x 2cm swelling at the left side of bridge of nose.  Computed Tomography showed a well-defined heterogenous soft tissue lesion with erosion of left nasal bone. Magnetic Resonance Imaging showed an isointense oval  mass over the left nasal bridge.  Aspiration cytology of lesion yielded spindle cells with bland nuclei. The lesion was excised surgically under general anaesthesia. Microscopically the lesion showed oval to spindle cells with bland nuclei arranged in storiform pattern along with inflammatory cell infiltrate. A diagnosis of Benign fibrous histiocytoma is made. Further Immunohistochemistry study confirmed this lesion as spindle cell neoplasm favouring benign fibrous histiocytoma.

Discussion:

Spindle cell tumour of bridge of nose is extremely rare. To the best of our knowledge, no such case has been reported till now in English medical literature. In our case, it was a well-localised, painful, mid-face, subdermal swelling without any ocular, oral lesions and nasal bone was only involved. Fine Needle Aspiration Cytology (FNAC), Magnetic resonance imaging (MRI) and Computed Tomography (CT) images are diagnostic tools for Spindle cell tumour. FNAC has a diagnostic accuracy of 84% and is characterised by the presence of spindle cells with bland nuclei. The treatment of spindle cell tumour is surgical and the approach depends on the extent and location of the tumour. In our case, we did Lynch-Howarth approach. Since the clinical presentation and pre-op FNAC did not suggest malignancy, we removed only the tumour and didn’t ensure oncological safe margins.