Isolated neurofibroma of the nasal vestibule: A rare case of the myxoid subtype and imaging-based differential diagnosis

Abstract

Myxoid neurofibromas are rare benign tumors that typically arise from the peripheral nerve sheath, with a predilection for the skin and subcutaneous tissues. Although uncommon in the sinonasal region, they can present diagnostic challenges due to their nonspecific clinical and radiologic features. While considered benign, neurofibromas carry a low but documented risk of malignant transformation into malignant peripheral nerve sheath tumors (MPNSTs), particularly in patients with neurofibromatosis type 1 (NF1). This transformation is extremely rare in sporadic solitary neurofibromas, but close clinical and radiologic follow-up remains advisable. We report a rare case of a neurofibroma located in the nasal vestibule, histologically classified as a myxoid subtype, in a 37-year-old male presenting with chronic unilateral nasal obstruction, mild epistaxis, and a progressively enlarging soft mass. A contrast-enhanced CT scan revealed a well-defined mass in the nasal cavity, and histopathological examination confirmed the diagnosis. Surgical excision was performed successfully via an endoscopic approach, with no recurrence noted at the six-month follow-up. This case highlights the importance of including neurofibroma—particularly in rare subsites such as the nasal vestibule—in the imaging differential diagnosis of nasal masses. It also underscores the essential role of histopathological analysis in confirming the diagnosis. Complete surgical excision remains the preferred treatment to prevent recurrence, and regular postoperative follow-up is recommended.

Keywords

• Myxoid neurofibroma
• Sinonasal tumors
• Nasal Obstruction
• Peripheral nerve sheath tumors
• Endoscopic exision