Intermittent Hemoptysis and Blood-Tinged Sputum

A 57-year-old man presented with a 3-week history of intermittent hemoptysis and blood-tinged sputum. He had a medical history of hypertension, type 2 diabetes mellitus, and right-sided thalamic infarction 1 year previously, and was currently taking aspirin therapy. Findings from a bronchoscopy demonstrated a normal bronchial tree and a nasopharyngeal mass. Nasal endoscopy revealed a pedunculated polypoid tumor with smooth, pinkto-red mucosa in the central nasopharyngeal roof (Figure, A). Findings from the rest of the head and neck examination, as well as from the complete blood cell count, biochemical tests, and chest radiograph, were unremarkable. A nasopharyngeal biopsy specimen was obtained under local anesthesia with limited bleeding. Histopathologic findings revealed l arge l ymphoid follicles c ontaining m ultiple germinal centers and many high endothelial venules in the interfollicular areas. Most of the lymphoid follicles had hyalinesclerosed germinal centers, with and without penetrating hyalin