Elsevier

Auris Nasus Larynx

Volume 29, Issue 4, 1 October 2002, Pages 335-339
Auris Nasus Larynx

Hemangioma of the nasal cavity: A clinicopathologic study

https://doi.org/10.1016/S0385-8146(02)00028-7Get rights and content

Abstract

Objective: The purpose of this study was determining the optimal surgical approach and preoperative examination for a hemangioma of the nasal cavity. We performed to summarize the indications of endoscopic surgery and its postoperative course. Methods: Eight patients with a history of epistaxis found to have an intranasal hemangioma were studied. Radiological study, postoperative course examination after the endoscopic surgery, and histological study were performed on these cases. Results: Preoperative computed tomography (CT) scan and MR image together with postoperative histological studies demonstrated characteristic figures of epithelioid hemangioma. Radiological studies were necessary to examine the extension of the tumor. The capillary type usually arose from the nasal septum while the cavernous type was seen in the lateral nasal wall. The postoperative course of the patient was uneventful, and no recurrence was found after endoscopic surgery in all cases. Conclusion: Radiological study was proven effective for the pre-surgical diagnosis. The hemangioma strictly pertaining to the nasal cavity can be completely treated by the endoscopic transnasal surgery. We suggest that the method inflict least stress on the patient and thus considered optimal.

Introduction

Although hemangioma are common lesions of the head and neck, those of the nasal cavity and paranasal sinuses are rare [1]. Some patients can present with severe epistaxis, which often mimics malignancy, often requiring immediate control with ointment gauze packing. Early biopsy for histological confirmation together with computed tomography (CT) scan and MR image are essential to establishing the diagnosis and management planning. We present four cases of patients with a nasal septum hemangioma that originated on the osseous portion and four others on the inferior or middle nasal turbinates. All the tumors were completely removed by the transnasal endoscopic surgery.

There are several methods of treating hemangioma. However, the best method of treatment appears to be wide resection of the tumor. Many surgical approaches were suggested including the natural orifice, transpalatal, transmandibular, lateral rhinotomy. We employ transnasal endoscopic technique for resection of hemangioma.

Section snippets

Materials and methods

The following study is based on a review of eight patients with hemangioma of the nasal cavity and referred to the Sumitomo Hospital spanning the years 1999–2001. All the patients had no history of nasal trauma or previous surgery. The age and gender of the patients are shown in Table 1. CT was performed in five patients, and six underwent magnetic resonance imaging (MRI), which demonstrated intranasal masses. Our series includes only one preoperative biopsy case performed in another hospital

Results

In all cases, rhinoscopy showed a purplish mass that filled the nasal cavity.

All masses were well-circumscribed with no internal calcification or phlebolites on CT scans. The nasal septum was displaced in two cases (Fig. 1), but the bone around the tumor was not eroded. MR images revealed all masses were located in the nasal cavity, and no invasion to paranasal sinuses was noticed. All the tumors were enhanced with Gd-DTPA on T1-weighted magnetic resonance images and showed high signal

Discussion

The presence of a bleeding nasal mass is consistent with various malignant and benign lesions. Although hemangioma of the head and neck are common. Over half of all hemangiomas are located in the head and neck region and can originate in the skin, mucosae and deep structures such as bones, muscles and glands. In the nasal cavity, about 80% of hemangiomas arise from the nasal septum in the area known as the Little area or Kiesselbach triangle. Another 15% arise from the lateral wall of the nasal

Conclusion

From this study it is possible to draw some conclusions:

CT scanning and MR imaging were useful in identifying the extension of the tumor and planning for the endoscopic transnasal surgery.

We suggest transnasal endoscopic approach can be taken for intranasal hemangioma limited to thenasal cavity to nasopharynx, and extended into ethomoid to sphenoid sinus.

References (23)

  • J.G. Batsakis et al.

    The pathology of head and neck tumors

    Head Neck Surg.

    (1981)
  • F. Yao-Sui et al.

    Non-epitherial tumors of the nasal cavity, paranasal sinuses,and nasopharynx: a clinicopathologic study

    Cancer

    (1974)
  • G.G. Christine et al.

    Diagnosis Quiz Case 3

    Arch. Otoraryngol. Head Neck Surg.

    (2000)
  • E.M. Stacey et al.

    Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma

    Am. J. Surg. Pathol.

    (1980)
  • R.M. Frank et al.

    Lobular capillary hemangioma of the nasal cavity

    Otolaryngol. Head Neck Surg.

    (1999)
  • J.L. James et al.

    Oral cavity pyogenic granuroma

    Arch. Dermatol.

    (1973)
  • H. Stephen et al.

    Pathologic quiz case1

    Arch. Otolaryngol. Head Neck Surg.

    (1986)
  • M.W.M. Bridger

    Hemangioma of the nasal bones

    J. Laryngol. Otol.

    (1976)
  • C.M. Myer et al.

    Hemangioma of the nasal septum

    J. Ear Nose Throat

    (1983)
  • A.D. Mark et al.

    “Bleeding Polyp” of the osseous nasal septum: a rarely seen lesion

    Am. J. Otolaryngol.

    (1995)
  • J.K. Hyung et al.

    Bone erosion caused by sinonasal cavernous hemangioma: CT finding in two patients

    Am. Soc. Neuroradiol.

    (1994)
  • Cited by (59)

    • Endoscopic resection of large endonasal hemangioma: Case report

      2020, International Journal of Surgery Case Reports
      Citation Excerpt :

      Even with the uncertainty of diagnosis, practitioners should be aware of the clinical, histological and radiological characteristics of sinonasal hemangiomas to avoid the consequences of a wrong diagnosis [5,7]. CT angiography is a valuable modality in visualizing vascular malformations and identifying the feeding vessel to the tumor, moreover, it can help in deciding the approach and possibility of using preoperative embolization [12,13]. Preoperative embolization has been shown to be effective in decreasing tumor size and minimizing intra and postoperative bleeding [3,5,7,14].

    • Imaging in Otolaryngology

      2018, Imaging in Otolaryngology
    • Features of sinonasal hemangioma: A retrospective study of 31 cases

      2017, Auris Nasus Larynx
      Citation Excerpt :

      Histological diagnosis confirmed a hemangioma in specimens from all 31 patients. From a histological point of view, hemangiomas have classically been classified into capillary hemangiomas, cavernous hemangiomas, or mixed type according to the dominant vessel size in the lesion at microscopy [1–3]. Specimens were histologically categorized as cavernous hemangiomas (n = 9; Fig. 2) and capillary hemangiomas (n = 22; Fig. 3).

    • Diagnostic Imaging: Head and Neck

      2017, Diagnostic Imaging: Head and Neck
    View all citing articles on Scopus
    View full text