Ectopic Pleomorphic Adenoma of the External Nose

Pleomorphic adenomas (PAs) are the most common benign salivary gland tumors but rarely present in ectopic locations. When ectopic PAs occur in the head and neck, they most often arise from minor salivary gland tissue of the oral or nasal cavities. PAs of the external nose are exceedingly rare, and this is the first report of a PA arising from the nasal bridge. Here, we report a case of an African American man in his mid-20s with no pertinent medical history who presented with a slowly enlarging left nasal bridge mass that had grown over the past two to three years. Initially attributed to prior facial trauma and managed as a keloid with steroid injections, the lesion failed to improve, prompting referral to otolaryngology. Ultrasound demonstrated a 1.1 × 1.7 × 1.2 cm heterogeneously hypoechoic subcutaneous mass, and MRI showed a T2 hyperintense, avidly enhancing mass closely associated with but not communicating with the nasolacrimal duct. En bloc excision was performed, and histopathology confirmed PA via characteristic biphasic morphology and diffuse PLAG1 positivity. This case represents the most superiorly located nasal PA in the literature, and the absence of nasolacrimal duct involvement suggests true ectopic origin rather than extension from recognized salivary elements. This case highlights the importance of maintaining a broad differential for external nasal masses, particularly when lesions fail to respond to treatment as expected.