Benign sinonasal capillary haemangioma

Abstract

SUMMARYHaemangiomas are benign fibrovascular tumours relatively that are common in the head and neck, where 60% of them occur Among the various categories of haemangiomas, lobular capillary haemangiomas (LCH) occur frequently on the skin, lips, buccal mucosa, tongue and gingiva. However, they are vanishingly rare in the paranasal sinuses. The imaging features of LCH are nonspecific. The histological characteristics of LCH can also make diagnosis difficult as sometimes resemble highly vascular malignant tumours. This leads to the false preoperative diagnosis of suspected malignancy in many cases, which places the patient under unnecessary distress and anxiety. We present a case of LCH appearing as a suspicious nasal lesion of the lateral nasal wall with unilateral nasal obstruction, necrotic centre and epistaxis. The tumour was excised endoscopically in one operation including endoscopic medial maxillectomy. Further education about this lesion is deemed important as preoperative embolisation may be needed for a safe operation. BACKGROUND

Lobular Capillary Hemangioma of the Ethmoid Sinus: A Report of Two Cases

“…LCH can be difficult to distinguish from a malignant tumor owing to their rapidly growth and bleeding and also other benign tumors. For example Darren Stubbs et al presented a case of LCH appearing as a suspicious nasal lesion of the lateral nasal wall with unilateral nasal obstruction and necrotic centre [17]. Perhaps the most clinically important lesions that need to be distinguished from a LCH are nasophaiyngeal angiofibroma, glomangiopericytoma and angiosarcoma.…”

Management of Capillary Hemangioma of the Sphenoid Sinus

“…It appears on the skin and in oral and nasal mucosa (especially the anterior nasal septum, turbinates, nasal vestibule, or nasopharynx) [ 3 , 4 ]. The etiology of lobular capillary hemangioma is not completely understood, but some theories take into account hormonal implication (particularly pregnancy and contraceptive use), injury, trauma, and viral infections [ 3 , 13 , 14 ]. Lobular capillary hemangioma can be encountered during pregnancy and is defined by the term “granuloma gravidarum”.…”

“…The symptoms can vary and depend on the location and size of the tumor, but unilateral nasal obstruction, recurrent unilateral epistaxis, and headache are among the commonest [ 14 , 17 , 18 ]. Hemangiomas are benign tumors with a slow growing rate.…”

“…Sometimes the histological diagnosis of capillary hemangioma can be difficult due to the endothelial proliferation pattern that resembles malignant lesions and ulceration that corresponds to granulation tissue [ 14 ]. Differential diagnosis can be made with nasal angiofibroma (when the patient is an adolescent male juvenile, angiofibroma can be taken into account), angiomatous polyp of the nose and sinuses, polypoid granulation tissue, inverted papilloma, lymphangioma, hemangiolymphangioma, glomangiopericytoma, or angiosarcoma [ 9 , 18 , 19 , 21 ].…”

Intralesional Bevacizumab for the Treatment of Recurrent Sinonasal Hemangioma

“…Although 60% of hemangiomas occur in the head and neck, 7 sinonasal hemangioma is a rare entity constituting just 2.5% of all hemangiomas and 12.5% of head and neck hemangiomas. 8 They present with the typical constellation of symptoms seen with intranasal neoplasms: progressive unilateral nasal obstruction, recurrent epistaxis, and rhinorrhea.…”