Vascular Leiomyoma of the Nasal Floor: The Risk of Misdiagnosis

Glomangiopericitoma: reporte de un caso / Glomangiopericytoma: a case report

El glomangiopericitoma es un tumor nasosinusal extremadamente raro, más frecuente en pacientes de edad avanzada y en mujeres. Si bien su etiopatogenia es desconocida, se reconocen ciertos factores predisponentes tales como hipertensión arterial, embarazo, trauma y uso de corticoides. Para su diagnóstico, resulta necesario recurrir tanto a estudio por imágenes como a la histología y técnicas de inmunohistoquímica. Microscópicamente se caracteriza por un prominente crecimiento perivascular de células uniformes ovales o fusiformes, dispuestas en fascículos cortos intercalados con capilares de diámetros variables ramificados en "asta de ciervo" y presenta inmuno-rreactividad positiva para actina, factor XIII-A y vimentina principalmente. Clínicamente este tumor presenta un comportamiento generalmente benigno, pero con una elevada tasa de recurrencia. Presentamos el caso de una mujer de 71 años, con antecedentes de hipertensión arterial, que acudió a nuestro centro por rinorrea purulenta y epistaxis unilateral derecha de 5 años de evolución. Al examen se observa masa polipoidea en fosa nasal derecha con abundante vascularización, sin otros hallazgos al examen físico. La lesión es resecada en su totalidad mediante cirugía endoscópica. El estudio histológico e inmunohistoquímico son compatibles con glomangiopericitoma. La paciente evoluciona con remisión de su sintomatología y a los dos meses desde la resección no ha presentado evidencias de recurrencia.

Glomangiopericytoma is an extremely rare sinonasal tumor, more common among elderly and women. Although its etiology and pathogeny are unknown, there are certain predisposing factors, such as arterial hypertension, pregnancy, trauma and corticosteroids. To diagnose this tumor, it is necessary imaging, histopathologic and inmunohistochemical studies. At the microscopic study, it is characterized by a prominent perivascular growth of oval-shaped or fusiform cells, arranged in short fascicles separated by capillary vessels of variable diameters, with staghorn-like ramifications, and lmmunohistochemistry positive mainly for actin, XIII-A factor and vimentin. Clinically, this tumor has a generally benign behavior, but with high recurrence percentage. We present the case of a 71 years old woman, with history of hypertension, who present in our center with a 5 years history of purulent rhinorrhea and right unilateral epistaxis, at the physical exam there is a polypoid mass in the right nasal fossa with rich vascularization, with no other findings. This tumor was resected entirely with endoscopic surgery. Histology and immunohistochemistry were compatible witch gomangiopericytoma. The patient evolve with remission of her symptoms and with no signs of recurrence at two-month follow-up.

Manejo endoscópico de papiloma invertido nasosinusal: experiencia de 15 años en Hospital Clínico Regional de Concepción / Endoscopic management of sinonasal inverted papilloma: 15 years experience in Concepción Clinical Hospital

Introducción: El papiloma invertido es uno de los tumores benignos más frecuentes de la región nasosinusal. Los principales problemas en su manejo son la recurrencia y transformación maligna. Su tratamiento es la extirpación quirúrgica. Objetivos: Describir y analizar las caracterfsticas cínicas y epidemiológicas, así como el resultado del tratamiento endoscópico practicado en el Hospital Clínico Regional de Concepción. Material y método: Se realizó un estudio retrospectivo, descriptivo, de todos los pacientes con diagnóstico de papiloma invertido nasosinusal operados vfa abordaje endoscópico entre los años 1997 y 2012. Se analizaron variables epidemiológicas y clínicas, incluyendo análisis de las recurrencias y transformación/asociación a cáncer. Resultados: Se encontraron 57 casos de papiloma invertido nasosinusal, 55 de los cuales se abordaron endoscópicamente, 65,5% hombres, 54,7 años en promedio de edad. La obstrucción nasal fue el principal síntoma. La mayor cantidad se concentró en estadio 2 (47,3%) y 3 (32,7%) de Krouse. Complicaciones relevantes 7,8%, las cuales fueron resueltas sin secuelas. Seguimiento promedio de 4,1 años, con una recurrencia de 5 (9,1%) casos, una persistencia (1,8%). Asociación con carcinoma escamoso en el 5,5% de los casos. Conclusión: La experiencia con la resección endoscópica en el papiloma invertido nasosinusal ha demostrado ser efectiva en nuestro medio, con baja tasa de complicaciones y recurrencias.

Introduction: The inverted papilloma is one of the most common benign tumors of the sinonasal region. The main problems in their management are the recurrence and malignant transformation. Their treatment is surgical removal. Aim: To describe and analyze the clinical and epidemiological characteristics, as well as the results of endoscopic treatment in a tertiary hospital. Materials and methods: A retrospective, descriptive study of all patients with diagnosis ofsinonasal inverted papilloma operated by endoscopic approach between 1997 and 2012 was carried out. Epidemiological and clinical variables were analyzed, including analysis of recurrences and transformation to / association with cancer. Results: 57 cases of sinonasal inverted papilloma were found, 55 of which were endoscopically resected, 65.5% male, 54.7 years old on average. Nasal obstruction was the main symptom. Most of them were in Krouse stage 2 (47.3%) and 3 (32.7%); 7.8% of major complications, which were resolved without sequels. The follow up average was 4.11 years, with a recurrence of 5 (9.1%) cases, and (1.8%) persistence. Association with squamous-cell carcinoma was found in 5.5% of cases. Conclusion: The clinical and epidemiological characteristics do not differ greatly from those reported in the literature. Experience with endoscopic resection in sinonasal inverted papilloma has proven effective in our clinical practice, with a low rate of complications and recurrences, this approach currently being the first choice in most cases.

Diagnosis,Treatment and Prognosis of Sinonasal Neuroendocrine Carcinoma / 昆明医科大学学报

Objective To study the diagnosis and treatment of neuroendocrine carcinoma of the nasal cavity and paranasal sinuses, and analyse the influencing factors of suvival and prognosis. Methods We retrospectively analyzed the diagnosis and treatment process of 14 patients with sinonasal neuroendocrine carcinoma (SNEC) admitted in The First Affiliated Hospital of Kunming Medical University from 2007 to 2011. All patients were followed up to learn the survival status of them.Results All patients were followed up for one year up to six years except 2 patients who gave up treatment. Five patients died and six survived with good tumor control in the followed up period. Two patients received only endoscopy surgery, and one of them died from lung metastasis in 21 months after operation, and the other one survived with good tumor control, the disease free survival (DFS) was 9 months . Eight patients were treated by endscopy surgery and /or chemo-radiotherapy, three cases died in following-up period, and five of them survivied with good tumor control, and the disease free survival was 20.25 months.Two patients with transcatheter arterial infusion chemotherapy survivied with good tumor control within the follow up period,and the DFS was 25.5 months.Five patients had moderately differentiated SNEC and DFS was 25.5 months. Seven patients had poorly differentiated SNEC with DFS 14.6 months. Six patients were T4N0M0, four patients were T3N0M0, two patients T2N0M0, and their DFS were 19 months, 12.8 months and 33 month, respectively. Conclusions Surgery with radiotherapy and/or chemotherapy is the current treatment method for sinonasal neuroendocrine carcinoma. Small cell neuroendocrine carcinoma with poor differiation displays highly aggressive and poor prognosis. Diagnosis and treatment in early stage is important for good prognosis.

Isolated Inverted Papilloma of the Sphenoid Sinus Presenting as Ptosis

Inverted papilloma is a rare form of a benign sinonasal tumor characterized by a potentially invasive nature. The lateral nasal wall represents the most common site of origin. In contrast, involvement of sphenoid sinus is exceedingly rare. The present study describes a case of a 52-years-old patient with an inverted papilloma which originated from the sphenoid sinus. The patient complained mainly of headache, ptosis and diplopia. Radiologic study revealed that the sphenoid sinus was completely occupied by the tumor. Additionally, the ethmoid sinus, cavernous sinus and intracranial fossa have been invaded by the tumor. Endoscopic sinus surgery and postoperative radiotherapy were performed. Two months after the operation, the patient has not revealed any new symptom. However, a remnant of the inverted papilloma still remains. The clinical presentation of the inverting papillomas confined to the sphenoid sinus is often non-specific and insidious, with ptosis and diplopia being predominant. The rhinologic surgeon has to rule out this condition.

Leiomioma vascular nasal gigante: informe de un caso y su manejo endoscópico transnasal: revisión de la literatura / Giant nasal vascular leiomyoma: transnasal endoscopic management: report of a case and review of the literature

El leiomiona vascular intranasal es extremadamente raro. Menos de 1% de todos los leiomiomas se localizan en cabeza y cuello y de éstos sólo 3% se encuentran en la cavidad nasal. Los síntomas clínicos más comunes son obstrucción nasal, epistaxis y dolor. Se informa el caso de un leiomioma vascular nasal en una mujer de 35 años cuyo tratamiento se hizo mediante cirugía endoscópica transnasal para resecar el leiomioma vascular nasal más grande hasta el momento se comunica en la literatura.

An intranasal vascular leiomyoma is extremely rare. Less than 1% of all leiomyomas originate in the head and neck area, and of these, only 3% are found in the nasal cavity. The most common symptoms are nasal obstruction, epistaxis and pain. A rare case of nasal vascular leiomyoma that developed in a 35 year old woman is reported. Transnasal endoscopic sinus surgery to perform a resection on the biggest nasal vascular leiomyoma ever found was made.