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Ansley W, Kajal S, Brar S, Lakhani R, Jayaram R, Weller A, Hulley K. Sphenopalatine artery pseudoaneurysm masquerading as a second primary maxillary carcinoma. Eur Arch Otorhinolaryngol 2024; 281:4419-4424. [PMID: 38695946 DOI: 10.1007/s00405-024-08685-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/12/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Maxillary sinus carcinomas usually present as a locally advanced disease at the time of diagnosis and it is extremely unusual to have a second primary maxillary carcinoma on the contralateral side after many years of completion of treatment of the first malignancy. We present here a case report of a sphenopalatine artery (SPA) pseudoaneurysm mimicking the second primary maxillary carcinoma. METHODS We reviewed the literature for SPA pseudoaneurysm. RESULTS/CASE REPORT This report describes the case of a 90-year-old man with a background of adenoid cystic carcinoma of the right maxillary sinus, diagnosed and treated with surgery and radiotherapy 14 years ago, who presented with a history of multiple episodes of epistaxis. The radiological evaluation showed a heterogeneously enhancing mass with a central hemorrhagic component and surrounding bony erosions in the left maxillary sinus and the patient was planned for biopsy from the suspicious mass along with SPA ligation. However, on opening the maxillary antrum there was excessive bleeding and it was determined unsafe to proceed further. The patient was subsequently taken to interventional radiology for diagnostic angiography which revealed an SPA pseudoaneurysm that was subsequently embolized successfully. CONCLUSIONS Sphenopalatine artery pseudoaneurysms should be considered as a differential for recurrent epistaxis in patients with a history of sinonasal malignancy. In such cases, endovascular embolization is a viable management option.
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MESH Headings
- Humans
- Male
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/diagnosis
- Aneurysm, False/therapy
- Aged, 80 and over
- Diagnosis, Differential
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/diagnostic imaging
- Neoplasms, Second Primary/pathology
- Maxillary Sinus Neoplasms/diagnosis
- Maxillary Sinus Neoplasms/diagnostic imaging
- Maxillary Sinus Neoplasms/pathology
- Carcinoma, Adenoid Cystic/diagnosis
- Carcinoma, Adenoid Cystic/diagnostic imaging
- Epistaxis/etiology
- Maxillary Artery/diagnostic imaging
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Affiliation(s)
- William Ansley
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Smile Kajal
- Department of Otolaryngology, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK.
- Rhinology Fellow, MedStar Union Memorial Hospital (Maryland ENT Center), Baltimore, MD, 21218, USA.
| | - Sabrina Brar
- Department of Otolaryngology, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK
| | - Raj Lakhani
- Department of Otolaryngology, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK
| | - Rahul Jayaram
- Department of Oral and Maxillofacial Surgery, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK
| | - Alex Weller
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK
| | - Kate Hulley
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK
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R B, N B, A Z, R H, K H, J K. Sinonasal Angiomatous Polyp: A Case Report and Review of Literature. EAR, NOSE & THROAT JOURNAL 2024:1455613241247731. [PMID: 38654494 DOI: 10.1177/01455613241247731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Sinonasal angiomatous polyp (SAP) is a benign pseudoneoplastic lesion rarely reported in the literature. It may be misdiagnosed as a malignant neoplasm due to its aggressive features of bone erosion clinically or on imaging. We report the case of a 43-year-old woman with a 3 month history of unilateral nasal obstruction with recurrent epistaxis. Nasal endoscopy showed polypoid nasal mass occupying the left nasal cavity. Imaging was suggestive of malignant vascular tumor. The patient underwent surgical excision after embolization. Histopathology concluded to the diagnosis of SAP.
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Affiliation(s)
- Bouatay R
- ENT Department at Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Bouaziz N
- ENT Department at Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
| | - Zrig A
- University of Monastir, Monastir, Tunisia
- Department of Radiology at Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
| | - Hadhri R
- University of Monastir, Monastir, Tunisia
- Department of Pathology at Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
| | - Harrathi K
- ENT Department at Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Koubaa J
- ENT Department at Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
- University of Monastir, Monastir, Tunisia
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3
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Zhao X, Yue C, Wan H, Xing L, Liu H, Piao Y. Angiectatic nasal polyps with pleomorphism ‒ a diagnostic pitfall. Braz J Otorhinolaryngol 2023; 89:101281. [PMID: 37413767 PMCID: PMC10391335 DOI: 10.1016/j.bjorl.2023.101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/26/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE To generalise the features of PANP in case of potential clinical and pathological pitfall of diagnosis. METHODS Thirteen patients diagnosed as PANP were retrospectively analyzed in the Pathology Department of Capital Medical University from August 2014 to December 2019. Immunohistochemical staining with CD34, CK, Vim, Calponin, Ki67, Bcl-2, and STAT-6 was performed with envision-two steps method. RESULTS PANP is a benign tumor presenting with gross variegated tan to gray soft fleshy tissue with foci of obvious hemorrhage and necrosis. The imaging shows internal heterogeneous hyperintensity with a peripheral hypointense rim while postcontrast images display a strong nodular and patchy enhancement. Vimentin (Vim) stain was consistently positive, while negative for CD34, STAT-6 and Bcl-2 (focal positive in two cases). Calponin and CK stain was positive in nine cases, respectively. CONCLUSION PANP is a clinically rare tumor which may simulate malignancy lesion. Recognizing of characteristic features in these thirteen patients would be beneficial to avoid misdiagnosis and unnecessary aggressive treatment. LEVEL OF EVIDENCE This work was Level 2 of evidence according to the Guide for Authors.
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Affiliation(s)
- Xiaoli Zhao
- Capital Medical University, Beijing Tongren Hospital, Department of Pathology, Dong Cheng District, China; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China
| | - Changli Yue
- Capital Medical University, Beijing Tongren Hospital, Department of Pathology, Dong Cheng District, China; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China
| | - Hongfei Wan
- Capital Medical University, Beijing Tongren Hospital, Department of Pathology, Dong Cheng District, China; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China
| | - Li Xing
- Capital Medical University, Beijing Tongren Hospital, Department of Pathology, Dong Cheng District, China; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China
| | - Honggang Liu
- Capital Medical University, Beijing Tongren Hospital, Department of Pathology, Dong Cheng District, China; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China
| | - Yingshi Piao
- Capital Medical University, Beijing Tongren Hospital, Department of Pathology, Dong Cheng District, China; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China.
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Jagadeeswaran VU, Vallur S, Shivanand JS. Management of Angiomatous Antrochoanal Polyp: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:1082-1087. [PMID: 36452723 PMCID: PMC9702278 DOI: 10.1007/s12070-020-02148-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
Antrochoanal polyps are the most common type of choanal polyp. Angiomatous polyp is a rare subtype of Antrochoanal polyp that might be misdiagnosed as malignant lesion due to its clinical features. A retrospective observational study was conducted in a tertiary care hospital in patients who were diagnosed with Angiomatous Antrochonal polyp that underwent functional endoscopic sinus surgery from 2017 to 2020. We analyzed the clinical symptoms, radiological findings, and pathological features of all patients diagnosed with Angiomatous Antrochonal polyp. Unilateral nasal obstruction, rhinorrhea, and epistaxis were the common symptoms. Antrochoanal polyps all originated from maxillary sinus and extended to nasal cavity with or without involving the nasopharynx. Expansile mass with surrounding bony destruction are typical on computed tomography imaging but specific for Angiomatous Antrochoanal polyp. The magnetic resonance revealed high signal intensity on T1-weighted images and hypo-intense rim on T2-weighted images. Computed tomography and magnetic resonance together might give rise to more accurate diagnosis of Angiomatous Antrochoanal polyp. Incisional biopsy does help if the clinician suspects a malignant lesion. Complete removal is treatment of choice for Angiomatous Antrochoanal polyp.
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Affiliation(s)
| | - Srujan Vallur
- Department of ENT, 12 Air Force Hospital, Akash Vihar, Kunraghat, Gorakhpur 273002 India
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Iemura-Kashiwagi M, Kikuchi M, Koyasu S, Kitada Y, Sugimoto A, Haga H, Nakamoto Y, Nakagawa T, Omori K. Angiomatous Nasal Polyp Diagnosed by Preoperative Imaging and Successfully Resected by Endonasal Endoscopic Surgery: A Case Report. Cureus 2021; 13:e18786. [PMID: 34796072 PMCID: PMC8590532 DOI: 10.7759/cureus.18786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/05/2022] Open
Abstract
Angiomatous polyp is a benign, nonneoplastic nasal polyp that accounts for 4-5% of all inflammatory nasal polyps but is rarely reported in the literature. It can grow rapidly and exhibit an aggressive clinical behavior that can simulate malignant sinonasal tumor. We herein report a case of a 13-year-old boy with a rapidly growing angiomatous polyp in the nasal cavity. We had followed up the patient without significant changes for two years, but the tumor had rapidly grown in the last six months. At first, the rapid growth of the tumor and the bone erosion of the maxilla were suggestive of a malignant tumor. However, with preoperative magnetic resonance imaging (MRI) and [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography imaging findings, we established the corrective diagnosis of an angiomatous polyp. After the diagnostic imaging, we performed an endoscopic endonasal surgery and totally resected the tumor without unnecessary excessive surgery. Recognition of this disease that can mimic malignancy is important to avoid excessive surgery such as en bloc resection by craniofacial approach, and we believe that MRI findings can be helpful for the imaging diagnosis.
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Affiliation(s)
| | - Masahiro Kikuchi
- Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Sho Koyasu
- Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Yuji Kitada
- Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | | | - Hironori Haga
- Diagnostic Pathology, Kyoto University Hospital, Kyoto, JPN
| | - Yuji Nakamoto
- Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Takayuki Nakagawa
- Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Koichi Omori
- Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, JPN
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6
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Purushothaman PK, Sharanya M, Manoj Pandian SP. Angiectatic Sinonasal Polyp: A Diagnostic Challenge. Indian J Otolaryngol Head Neck Surg 2020; 73:260-262. [PMID: 34150602 DOI: 10.1007/s12070-020-02125-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022] Open
Abstract
Sinonasal angiectatic polyp is an uncommon condition with features that masquerade various pathologies like hemangioma, angiofibroma, inverted papilloma, malignancy. We report a case of a left-sided vascular nasal mass, which on examination and investigations suggested cavernous hemangioma of the left maxillary sinus, whereas histopathology post-excision revealed angiectatic polyp.
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Affiliation(s)
- P K Purushothaman
- Department of Otorhinolaryngology, SRM Medical College Hospital and Research Institute, Kattankulathur, Kancheepuram, Tamil Nadu India
| | - M Sharanya
- Department of Otorhinolaryngology, SRM Medical College Hospital and Research Institute, Kattankulathur, Kancheepuram, Tamil Nadu India
| | - S P Manoj Pandian
- Department of Otorhinolaryngology, SRM Medical College Hospital and Research Institute, Kattankulathur, Kancheepuram, Tamil Nadu India
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Computed tomography and magnetic resonance imaging of adenoid cystic carcinoma in the maxillary sinus: a retrospective study with radiologic-histopathologic correlations. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:111-121. [PMID: 32712057 DOI: 10.1016/j.oooo.2020.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to investigate computed tomography (CT) and magnetic resonance imaging (MRI) findings in adenoid cystic carcinoma (ACC) in the maxillary sinus and their correlations with the tubular, cribriform, and solid histopathologic types of ACC. STUDY DESIGN Twenty cases of histopathologically proven ACC in the maxillary sinus were retrospectively reviewed. CT and MRI findings were correlated with histopathologic results. RESULTS On CT, significant differences were discovered among the 3 histopathologic ACC types in range, size, shape, margins, type of bone destruction, and time intensity curve (TIC) (P ≤ .018). Tubular lesions were limited in range, were smaller than the other types, produced small cystic patterns with well-defined margins, and caused a cribriform pattern of bone destruction. All tumors demonstrated heterogeneous intensity signal on T1- and T2-weighted images (T1WI and T2WI) and appeared as hypo- or isointense small cystic lesions on T1WI and hyperintense on T2WI (n = 6). Postcontrast MRI revealed marked heterogeneous enhancement for all lesions. The TIC showed a rapidly enhancing and slow washout pattern in all tubular lesions and a rapidly enhancing and rapid washout pattern in solid tumors. CONCLUSIONS Different histologic patterns of ACCs have distinctive radiologic features, which can facilitate accurate preoperative diagnosis.
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8
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Assiri KS, Al-Ahmari MS, Alshahrani MS, Mastor A, Elhawary R. Clinical and Pathological Features of Angiomatous Nasal Polyps: A Report of Four Cases and Review of Literature. Cureus 2020; 12:e7642. [PMID: 32411544 PMCID: PMC7217259 DOI: 10.7759/cureus.7642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/11/2020] [Indexed: 02/01/2023] Open
Abstract
Inflammatory or allergic sinonasal polyps are characterized by extensive vascular growth and ectasia with deposition of pseudoamyloid in 5% of cases. Angiomatous nasal polyp (ANP) is a relatively rare benign lesion, which may be misdiagnosed as a benign or malignant tumor. The characteristic pathological features of ANP are expanded angiogenesis, accumulation of extracellular amorphous eosinophilic substance, and atypical stromal cells. This report aimed to outline the histological differential diagnosis of ANP. Through a full histopathological examination, we studied biopsies and resected specimens from five patients who were diagnosed with ANPs, including one with facial deformity. Gross findings showed that tumors were firm in consistency, lobulated on the surface, and lined by partially ulcerated mucous membrane. Light microscopy showed clusters of widened, thin-walled blood vessels among congo red-negative eosinophilic substance with an area of necrosis and irregular stromal spindle cells. Presence of endothelial cell myofibroblasts were confirmed by electron microscopy and immunohistochemistry. This is a report of four cases which showed extreme examples of ANPs that was completely resected by endoscopic sinus surgery for all patients. A full histopathological examination is recommended to confirm the possible differential diagnoses for a better management plan.
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Affiliation(s)
| | | | | | - Ali Mastor
- Otolaryngology, Khamis Mushayt General Hospital, Khamis Mushayt, SAU
| | - Reda Elhawary
- Pathology, Al-Azhar University, Cairo, EGY
- Pathology, Khamis Mushayt General Hospital, Khamis Mushayt, SAU
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Wang X, Liu Y, Chen Q, Xian J. Evaluation of multiparametric MRI differentiating sinonasal angiomatous polyp from malignant tumors. Neuroradiology 2019; 61:891-896. [PMID: 31119344 DOI: 10.1007/s00234-019-02225-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Sinonasal angiomatous polyps (SAPs) can be misdiagnosed as malignant tumors due to aggressive clinical behaviors. The purpose of this study was to evaluate the diagnostic accuracy of multiparametric MRI in differentiating SAPs from malignant tumors. METHODS This retrospective study included 31 patients with pathologically proven SAPs and 36 patients with malignant tumors in maxillary sinus and nasal cavity. All the patients underwent conventional MRI and dynamic contrast-enhanced (DCE) MRI on 3T MR scanners. Diffusion-weighted (DW) MR imaging was performed in 45 patients. All the MR images were retrospectively analyzed independently by two authors. RESULTS Significant differences were found in T1 homogeneity, T2 signal intensity ratio, peripheral hypointense rim on T2WI, and soft tissue infiltration between SAP and malignant tumors (P = 0.004, < 0.001, < 0.001, and = 0.001, respectively). SAPs usually show heterogeneous signal intensity on T1WI, peripheral hypointense rim on T2WI, and higher T2 signal intensity ratio. The tumor size of SAP (4.01 ± 1.08 cm) was slightly smaller than that of malignant tumors (4.56 ± 1.12 cm) (P = 0.045). There were significant differences in DCE-MRI parameters including Tpeak, CImax, WR, TIC types, and progressive enhancement (P = 0.009, < 0.001, = 0.001, = 0.001, and < 0.001, respectively) between SAPs and malignant tumors. All the 31 SAPs showed progressive enhancement on DCE-MRI, while none of the malignant tumors showed progressive enhancement (accuracy 100%). The mean ADC of SAP (1.75 ± 0.30 × 10-3 mm2/s) was higher than that of malignant tumors (1.18 ± 0.31 × 10-3 mm2/s) (P < 0.001). CONCLUSION Multiparametric MRI showed high diagnostic performance in differentiating SAPs from malignant tumors. Progressive enhancement on DCE-MRI is the most effective feature of SAP.
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Affiliation(s)
- Xinyan Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ying Liu
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, Fujian, China
| | - Qinghua Chen
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Idris AI, Ramli RR, Sachlin IS. Angiomatous antrochoanal polyps: Challenge in diagnosis. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.ejenta.2016.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Tam YY, Wu CC, Lee TJ, Lin YY, Chen TD, Huang CC. The clinicopathological features of sinonasal angiomatous polyps. Int J Gen Med 2016; 9:207-12. [PMID: 27382326 PMCID: PMC4918889 DOI: 10.2147/ijgm.s104628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sinonasal angiomatous polyp (SAP) is a rare subtype of sinonasal polyp that might be misdiagnosed as a malignant lesion due to its clinical symptoms. METHODS We retrospectively enrolled the patients who were diagnosed with SAP in our hospital during 2008-2015. We analyzed the clinical symptoms, radiological findings, and pathological features of all patients diagnosed with SAP. RESULTS Unilateral nasal obstruction, rhinorrhea, and epistaxis were the common symptoms. SAPs all originated from maxillary sinus and extended to nasal cavity with or without involving the nasopharynx. Expansile mass with surrounding bony destruction is typical on computed tomography imaging but specific for SAPs. The magnetic resonance revealed high signal intensity on T1-weighted images and hypointense rim on T2-weighted images. CONCLUSION Computed tomography and magnetic resonance together might give rise to more accurate diagnosis of SAP. Incisional biopsy does help if the clinician suspects a malignant lesion. To treat SAP, complete removal is the optimal choice.
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Affiliation(s)
- Yuan-Yun Tam
- Department of Otorhinolaryngology - Head and Neck Surgery, Lotung Poh-Ai Hospital, Yilan County, Taiwan
| | - Chia-Chen Wu
- Department of Otorhinolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan County, Taiwan
| | - Ta-Jen Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan County, Taiwan
| | - Yang-Yu Lin
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan County, Taiwan
| | - Tai-Di Chen
- Department of Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan County, Taiwan
| | - Chi-Che Huang
- Department of Otorhinolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan County, Taiwan
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Pang W, Hu L, Wang H, Sha Y, Ma N, Wang S, Liu Q, Sun X, Wang D. Organized Hematoma: An Analysis of 84 Cases with Emphasis on Difficult Prediction and Favorable Management. Otolaryngol Head Neck Surg 2016; 154:626-33. [PMID: 26861229 DOI: 10.1177/0194599815625956] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/16/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize features of organized hematoma (OH) that may cause considerable diagnostic difficulties. STUDY DESIGN Case series with chart review. SETTING Tertiary medical center. SUBJECTS AND METHODS Eighty-four patients with pathologically confirmed OH over a 10-year period were retrospectively reviewed for clinical features, imaging findings, pathologic characteristics, and treatment modalities. RESULTS This study included 39 males and 45 females who presented with frequent epistaxis and nasal obstruction. There were 62 (74%) patients >40 years old (mean, 50; range, 9-81). OH mainly originated in the maxillary sinus (n = 82) or nasal cavity (n = 2) unilaterally, and most were expansile masses (n = 73) that extended into nasal cavity (n = 71) or choanae (n = 17). Several lesions were locally aggressive and simulated a malignant process that involved the ethmoid sinus (n = 22), orbit (n = 11), pterygopalatine fossa (n = 16), infratemporal fossa (n = 9), cheek (n = 3), and hard palate (n = 3). Internal architecture on computed tomography (CT) scans showed OH with expansile remodeling of the maxillary wall (82.1%) and smooth bony destruction (70.2%), whereas T2-weighted magnetic resonance (MR) images showed inhomogeneity with a notable hypointense peripheral rim in all lesions. CT and MR contrast-enhanced images revealed patchy heterogeneous enhancement that could be interpreted according to histopathologic findings of hemorrhage and neovascularization. OH was successfully removed with endoscopic surgery, although 5 cases recurred. CONCLUSIONS OH can be successfully treated by endoscopic surgery. CT and MR examination provide characteristic findings for prediction and careful surgical planning.
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Affiliation(s)
- Wenhui Pang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Li Hu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Yan Sha
- Department of Radiology, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Na Ma
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Shuyi Wang
- Department of Pathology, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Quan Liu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Xicai Sun
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Dehui Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
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13
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Ding C, Wang Q, Guo Q, Wang Z, Lu X, Zhang J. Sinonasal Angiomatous Polyp: Evaluation With 2-Phase Helical Computed Tomography. Medicine (Baltimore) 2015. [PMID: 26200632 PMCID: PMC4602999 DOI: 10.1097/md.0000000000001196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sinonasal angiomatous polyp (SAP) is a rare benign nontumorous lesion and previously considered lack of characteristic computed tomography (CT) findings. This study aimed to evaluate 2-phase helical CT for characterization of SAP. Twelve patients with pathologically confirmed SAP underwent 2-phase helical CT preoperatively. After injection of 80 mL contrast material at a rate of 3 mL/s, early and delayed phases were obtained with delays of 30 and 120 s, respectively. The degree and pattern of enhancement were visually analyzed. The attenuation changes were also analyzed quantitatively by measuring CT values and compared with those of the internal maxillary artery (IMA). All 12 cases showed vessel-like marked heterogeneous enhancement at both early and delayed phases. An irregular linear, nodular, and patchy enhancement pattern was found at the early phase, and enlarged and fused together, that is, progressive enhancement pattern was found at the delayed phase. There was no significant difference between the CT values of SAP and those of the IMA at the plain, arterial phase, and delayed phase (53 ± 6 Hounsfield units [HU] vs 56 ± 7 HU, 187 ± 56 HU vs 209 ± 71 HU, and 143 ± 22 HU vs 139 ± 19 HU, respectively, P = 0.361, 0.429, and 0.613, respectively). Vessel-like marked heterogeneous enhancement was a characteristic CT feature of SAP, and progressive enhancement on 2-phase helical CT could further convince the diagnosis.
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Affiliation(s)
- Changwei Ding
- From the Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China (CD, QW, QG, JZ); Department of Nasology, Shengjing Hospital of China Medical University, Shenyang, P.R. China (ZW); and CT Clinical Science, Philips Healthcare, Shenyang, China (XL)
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