Endoscopic sinus surgery for sinonasal haemangiopericytomas

Abstract

Haemangiopericytomas are rare peri-vascular tumours with variable malignant potential. The nasal cavity and the paranasal sinuses are most often involved in the head and neck. Five cases of haemangiopericytomas treated by a strict endonasal endoscopic approach are presented. Bleeding and nasal obstruction are the most frequent symptoms. Computed tomography (CT) scan and magnetic resonance imaging (MRI) allowed pre-operative assessment. Angiography with embolization was needed in two of the five cases. None of our patients presented with malignant histology. Our five cases were operated on, and a total tumour excision was performed through the endoscopic endonasal approach. We had one recurrence with a mean follow-up of 4.5 years. We suggest that when the tumour is purely intranasal or strictly located in the ethmoid or sphenoid sinus, it can be removed via an endonasal approach under endoscopic guidance in experienced hands.

Endoscopic Resection of Sinonasal Hemangiomas and Hemangiopericytomas

“…Others have reported hemangiopericytoma recurrence rates in the range of 12-20% [6,7] . Serrano et al [6] used endoscopic resection techniques and had 1 recurrence in their 5 patients at 4.5 years of follow-up. Our series examined vascular neoplasms with low malignant potential (hemangiopericytomas) and benign vascular neoplasms (hemangiomas).…”

“…As experience with endoscopic surgery grows, it is being increasingly applied to neoplastic disease of the sinuses [1] . While most reports have dealt with endoscopic resection of inverted papilloma [2] , there have been few case reports describing endoscopic resection of vascular neoplasms, and most of these have described endoscopic resection of juvenile nasopharyngeal angiofi bromas [3][4][5][6] .…”

Glomangiopericytoma (sinonasal-type haemangiopericytoma)

“…However, the majority of authors advocate angiography in larger tumours, in order not only to facilitate pre-operative planning but also to enable embolisation, which in turn significantly reduces the risk of intraoperative haemorrhage. 8,10,12 Stout and Murray were the first to describe haemangiopericytoma, in 1942, as vascular soft tissue tumours of presumed pericytic origin. 4,10 The histological features of haemangiopericytoma consist of uniform, spindle-shaped cells with indistinct cytoplasm and large nuclei, distributed around vascular channels which typically exhibit a stag horn branching pattern.…”

“…4,10 The histological features of haemangiopericytoma consist of uniform, spindle-shaped cells with indistinct cytoplasm and large nuclei, distributed around vascular channels which typically exhibit a stag horn branching pattern. 12 The vascular channels are often more readily defined following reticulin staining, which clearly demonstrates the proliferation of tumour cells outside the vascular sheath. 2 However, since its initial description the characteristic histological features encountered in haemangiopericytoma have been found to be nonspecific and encountered in up to 15 per cent of unrelated soft tissue neoplasms.…”

“…2 However, the overwhelming weight of opinion supports the principles of an 'oncological plane' and en bloc excision with clear margins, in order to reduce the potential for recurrence, as these neoplasms are relatively radioresistant. 8,10,12 Traditionally, this has been achieved through a variety of approaches, including craniofacial resection (considered to be the 'gold standard'), lateral rhinotomy and mid-facial degloving, all of which are associated with significant morbidity and major complications in up to 40 per cent of cases. 2,8,9 Endoscopic surgery of the nasal cavity and paranasal sinuses has evolved to the extent that it is now the preferred means of treatment for both benign and malignant neoplasms of the nasal cavity as well as the anterior skull base.…”