Endoscopic Resection of a Giant Sinonasal Haemangiopericytoma with Preoperative Embolization and Cyanoacrylate Glue Injections: A Case Report and Literature Review

Abstract

Background: Hemangiopericytomas (HPC) are rare mesenchymal tumors, which arise from the degeneration of Zimmerman's pericytes. They develop in the head and neck soft tissues in about 25% of cases and, in more than 50% of cases they involve the sinonasal region, especially the sphenoid sinus and ethmoidal labyrinth. Methods:We report the case of a 71-year-old caucasian male, with a history of recurrent epistaxis followed by total nasal obstruction and anosmia. Radiographic and endoscopic examinations revealed a multilobed hypervascularized mass (49x 59x 49mm), occupying the nasal cavity and the paranasal sinuses. Pre-operative embolization, followed by intratumoral direct injections of cyanoacrylate glue, was carried out. A completely endoscopic resection was then performed.Results: Post-operative histopatological and immunoistochemical examinations confirmed a sinonasal HPC. Endoscopic and radiological 2-year follow-up did not show any tumor recurrence. Conclusion:Endoscopic intranasal excision under endoscopic guidance, with preceded by embolization and direct cyanoacrylate glue injections, is an effective treatment for sinonasal HPC.