Endoscopic Resection of Sinonasal Hemangiopericytoma following Preoperative Embolisation: A Case Report and Literature Review

Abstract

Objectives. Hemangiopericytoma is a rare tumor entity deriving from pericytes. Less than 5% of hemangiopericytoma occur in the nasal cavity and are characterised by a rather benign nature with low tendency of metastasis. However, as the recurrence rate in the literature ranges from 9.5% to 50%—depending on the length of followup—a radical surgical resection is considered as the gold-standard treatment. Only a few years ago, a wide external approach, usually via lateral rhinotomy or Caldwell-Luc, was performed. Endoscopic techniques were regarded as appropriate for small low-vascularised tumors only. Methods. We present the case of a 64-year-old patient with an extended sinonasal hemangiopericytoma, who was successfully treated by an endoscopic controlled endonasal tumor resection after embolisation with Onyx. Further, to support the new treatment option, we review the literature concerning all features of sinonasal hemangiopericytomas and their therapeutical management. Results/Conclusion. Onyx, which has not been described in the context of hemangiopericytoma yet, is a very effective embolic agent for a preoperative embolisation of sinonasal hemangiopericytoma allowing a safe endoscopic surgery.

A population‐based analysis of Head and Neck hemangiopericytoma

“…There was also a strong predominance of HN‐HPC for white patients. Overall, these findings are consistent with those previously reported in the literature . Head and neck HPC most commonly occurred in the connective and soft tissues of the head and neck, followed by the sinonasal cavities and orbit.…”

“…Overall, these findings are consistent with those previously reported in the literature. 2,4,5,11,12 Head and neck HPC most commonly occurred in the connective and soft tissues of the head and neck, followed by the sinonasal cavities and orbit. Compared to Other-HPC, HN-HPC presented at a significantly smaller tumor size, averaging 4.5 cm.…”

Characteristics and prognosis of glomangiopericytomas: A systematic review

“…After full‐text assessment, 139 articles were also excluded: articles containing no histologic findings (n = 20), unclear histology (n = 10), duplicate cases (n = 3), cases not arising in the sinonasal tract (n = 21), other sinonasal tumors, such as solitary fibrous tumor (n = 39), glomus tumor (n = 27), myopericytoma (n = 3), fibroma (n = 1), papilloma (n = 1), and lymphoma (n = 1), and reviews without information about individual cases (n = 13). Finally, 80 articles containing glomangiopericytoma of the sinonasal tract (337 cases) were identified as eligible for this study . Most articles (75/80; 94%) were published in English, except for 5 articles written in Korean …”

Sinonasal glomangiopericytoma treated with preoperative embolisation and endoscopic sinus surgery

“…In the literature, preoperative embolisation before resection of GPC has been reported in less than 23 patients [14, 16]. …”

“…Metastatic rates (5–10%) of these tumours are generally lower than those (12–60%) of HPC at other sites. Radiotherapy and chemotherapy can be used as both adjuvant therapy and palliation therapy for metastatic disease [14, 16]. …”