A CASE OF FIBROMA OF THE NASAL FOSSA. 
CHARLES H. KNIGHT, M.D. 
TUMORS of the nasal fossae made up in part of fibrous tis- 
sue, are not uncommon, many cases of fibro-sarcoma 
and of fibro-myxoma being on record. Fibromata of the naso- 
pharynx are much more frequent. The explanation of this 
fact, generally accepted, is that the deep layer of fibroustissue 
is denser and more plentiful at the upper and posterior parts 
of the nasal chambers and in the vault of the pharynx, than 
elsewhere in the upper air tract. 
In a paper read at the Ninth International Medical Congress 
in 1887, Casselberry tabulated eight cases of intra-nasal tumor, 
in three of which, including one of his own, the diagnosis of 
fibroma was verified by the microscope. One was a fibro sar- 
coma, one a fibro-myxoma, and the remaining three were 
designated fibromata, although no microscopic examination 
was made. In one of these last, death resulted from hemor- 
rhage following an attempt at removal of the tumor, a fact 
which would tend to throw suspicion on the diagnosis. By 
many observers vascularity is said to be a characteristic of a 
fibroma, and epistaxis is mentioned as an early and constant 
clinical sign. Spontaneous hemorrhage, as a frequent occur- 
rence or in excess is always suggestive of malignancy. What- 
ever may be the rule as to the naso-pharynx, it is believed that 
pure fibromata of the nasal fossa, at least if pedunculated, are 
not dangerously vascular growths. A diagnosis of these neo- 
plasms should always rest upon the microscopic examination. 
The admixture of sarcomatous, myxomatous, or other elements 
in many of the cases on record reduces the number of genuine 
fibromata to a very small figure. On these grounds we should 
be justified in excluding a large proportion of Bosworth's 
collection of forty-one cases of so-called fibroma. 
Reprinted from Manhattan Eye and Ear Hospital Reports, Jan., 1895 104 
KNIGHT. 
Since the date of this report a single case of fibroma has 
been reported, that exhibited by Gerber, January 8, 1894, 
and referred to in the Journal of Laryngology, April, 1894. In 
1893, Stoker gave the history of a case of what he calls " soft 
fibromata," vascular papillary growths of the middle and in- 
ferior turbinated bodies, evidently not genuine fibrous tumors. 
A similar case of " soft fibroma " of the nasal septum has been 
reported by Victor Lange, and is abstracted in the Journal of 
Laryngology, February, 1894. In the Charlotte Medical 
Journal, January, 1895, Dr. W. H. Wakefield reports a case 
of nasal fibroma. It does not appear that the diagnosis was 
confirmed by the microscope, and the precise implantation of 
the tumor remains in some doubt its point of attachment not 
having been determined before its removal. 
The history of my own case is as follows : 
G. T. D., aet. 21, came to me in 1889 with the usual symp- 
toms of nasal catarrh, which had been present for several years. 
The left nostril in particular was obstructed. There was no 
pain. The sense of smell was not impaired. There had never 
been any hemorrhage. The general health was excellent, ex- 
cept for a persistent cough with moderate expectoration, which 
led the patient to apprehend pulmonary disease. The lungs, 
however, were sound. On anterior rhinoscopy the septum was 
seen to be somewhat deflected to the left, and far back in the 
left nasal fossa could be detected a smooth, movable tumor at- 
tached to the posterior end of the middle turbinated body. In 
the rhinoscopic mirror the tumor appeared nearly to fill the left 
choana. It was smooth, round, symmetrical, and decidedly 
darker in color than the average cedematous polyp, and, more- 
over, was evidently denser in structure. Nevertheless, it was 
thought to be an ordinary gelatinous growth containing an un- 
usual proportion of fibrous tissue. 
The removal of the tumor was easily accomplished under 
cocaine, by means of the cold wire snare, and was followed, of 
course, by great relief as regards the breathing, and by con- 
siderable improvement in the general catarrhal symptoms. 
The after-treatment consisted in the use of sprays, cleansing 
and sedative in character, and the reduction of turbinated 
hypertrophies with the galvano-cautery. There has been no 
recurrence of the growth. 
The chief interest of this case centres in the microscopic A CASE OF FIBROMA OF THE NASAL FOSSA. 
105 
character of the tumor, which is a pu> e fibroma. Several sec- 
tions have been examined by my friend, Dr. Jonathan Wright, 
who reports that he has been unable to find the slighest trace 
of so-called myxomatous structure. The density and absence 
of vascularity in the growth are very marked, and near the sur- 
face, at certain points, collections of small round cells sugges- 
tive of sarcoma, but of inflammatory origin, are conspicuous. 
In general the fibrous structure is perfectly distinct, and 
becomes more marked towards the middle of the tumor.