A rare case of intranasal vascular leiomyoma

Diagnosis, Treatment and Follow-Up of Sinonasal Leiomyomas: A Systematic Review

BACKGROUND

Leiomyomas are benign smooth muscle tumors that are rarely diagnosed in the nasal cavity and paranasal sinuses.

OBJECTIVE

This systematic review summarizes the histopathologic and clinical tumor characteristics, surgical management, and follow-up of sinonasal leiomyomas.

METHODS

A systematic review of the literature on sinonasal leiomyoma was performed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies that met the inclusion criteria were assessed for level of evidence. Patient demographics, clinical and pathological tumor characteristics, primary intervention, and results of follow-up were evaluated.

RESULTS

Forty studies including 84 patients with sinonasal leiomyoma were identified. The tumor was most often located in the nasal cavity (47/84, 56%) originating from the inferior turbinate (32/84, 38%). Patients mostly presented with symptoms originating from an intranasal mass, including recurrent epistaxis (41/84, 49%), nasal obstruction (43/84, 51.2%), and localized facial or head pain (25/84, 29.8%). Surgery was performed in all cases. An endoscopic approach was most frequently chosen. Recurrence occurred only twice (2.4%). Morbidity was noted in 2 cases (2.4%) following postoperative bleeding and 1 (1.2%) case following a CSF leak.

CONCLUSION

Sinonasal leiomyomas are neoplasms of the smooth muscle manifesting clinically with recurrent epistaxis and nasal obstruction. Management goal is total resection with clear margins to avoid local recurrence.

Epistaxis caused by nasal septum angioleiomyoma

BACKGROUND: Angioleiomyoma is an uncommon, benign tumour originating from vascular smooth muscle. Occurrence in the nasal cavity, especially the nasal septum, is rare with only 16 cases of nasal septal angioleiomyoma reported thus far. We present a new case of nasal septal angioleiomyoma. CASE PRESENTATION: 52-year-old female presented with a three-week history of persistent epistaxis and nasal obstruction. Physical examination revealed a right sided nasal mass originating from the septum. The tumour was endoscopically excised and sent for pathological evaluation which revealed the diagnosis of angioleiomyoma. The patient was followed for six months postoperati- vely and showed no evidence of lesion recurrence. CONCLUSIONS: Because nasal cavity angioleiomyoma recurrence has been reported due to incomplete tumour resection, wide marginal excision is necessary for successful treatment. There have been no cases of malignant transformation of nasal angiolei- omyomas; however, malignant transformation at other sites has been reported. For these reasons, it is important to adequately biopsy and remove angioleiomyoma lesions.