Intraosseous hemangioma of the vomer: a case report

Unusual presentation and histopathology of bilateral nasal polypi; cavernous hemangioma (right) and inverted papilloma (left)

Hemangiomas are common lesions in medical practice, but those arising in the nasal cavity and/or paranasal sinuses are rare. Inverted papilloma is a rare benign tumor with a high incidence rate in both the nasal cavity and sinuses. The presence of both lesions in the same patient is even rarer. Here we present a case of a male patient with an unusual presentation and dual pathologies of cavernous hemangioma and inverted papilloma of the sinonasal tract that underwent endoscopic surgery and showed no recurrence of disease after a 2-year follow-up. The association of nasal cavernous hemangioma at one side and inverted papilloma at the other side is a very rare occasion that requires further studies and histopathology is the only diagnostic tool.

68Ga-DOTATATE Uptake in an Intraosseous Hemangioma, as a Potential Cause of False-Positive PET/CT Finding, Simulating Tumoral Involvement

ABSTRACT

We present the case of a 32-year-old man with a history of hypophosphatemia and multiple bone fractures, being evaluated at our center for a potential mesenchymal tumor. 68Ga-DOTATATE PET/CT revealed a highly 68Ga-DOTATATE-avid lesion in the ethmoidal sinus extending to the nasal cavity. Following resection, histologic examination of the specimen confirmed the diagnosis of "intraosseous hemangioma," a potential cause of false-positive finding of 68Ga-DOTATATE PET/CT imaging in patients being evaluated for occult malignancies, especially at the traumatic/fractured sites.

Le Fort I Down-Fracture for Management of Midface Tumors

OBJECTIVE

To perform an integrative review associating current literature with a clinical series regarding the use of Le Fort I osteotomy for the removal of tumors located in the midface and central region of the skull base.

METHODS

A systematic review was performed through the PubMed, SCOPUS, and Cochrane databases. In addition, 4 different patients operated using the above-cited technique are described in this study.

RESULTS

Initially, 123 articles were found. After the removal of duplicates, and title and abstract reading, 27 articles were selected for data extraction. The Le Fort I surgical approach of tumors was performed in 183 patients.

CONCLUSION

The Le Fort I surgical approach allows lesion exeresis with good visualization, low rates of recurrences and complications, and without aesthetic compromises for the patient.

Nasal Septal Cavernous Hemangioma

Hemangiomas are benign tumors originating from the skin, mucosa, muscle, gland, and vascular tissue in the bone. Although it is common in the head and neck region, it is rarely seen in the nasal cavity and paranasal sinuses. Histologically capillary, cavernous, and mixed types are present, the most common is cavernous-type hemangioma. Cavernous hemangiomas in the nasal cavity, generally originated from the lateral nasal wall, cause symptoms as nasal obstruction and epistaxis. In the author's patient, cavernous hemangioma was originated from the nasal septum, where rarely seen. The author wanted to discuss this rare disease by presenting a 78-year-old woman who presented with nasal obstruction and recurrent epistaxis to the author's clinic.

Cavernous hemangioma of rhinopharynx: our experience and review of literature

Hemangiomas are benign tumors originating in the vascular tissues of skin, mucosa, muscles, glands, and bones. Although these tumors are common lesions of the head and neck, they rarely occur in the nasal cavity and paranasal sinuses. Cavernous haemangioma of the lateral wall of the nasopharynx has not previously been reported. We examined the clinical, radiological and therapeutic management of cavernous haemangioma of nasopharynx starting from a clinical case of a 26-year-old woman with a history of recurrent and conspicuous epistaxis and left-sided nasal associated severe obstruction. Nasopharynx examination, by flexible endoscopy, showed a cystic mass borne by the left side wall of the nasopharynx, in contact with the soft palate, covered by intact and regular mucosa. Contrast-enhanced computed tomography (CT) scan, confirmed these findings and showed contextual lamellar calcifications and inhomogeneous enhancement. The nasal endoscopic approach (FESS), under general anesthesia, allowed removal of the mass, without complications, after careful hemostasis of arterial branches. It was possible to establish the precise site of origin of the tumor only during the surgical procedure. Histopathological study showed mucosa with extensive vascular proliferation, with framework of lacunar/cavernous haemangioma, also present at lamellar bone tissue level. An unusual site and an unspecific clinical appearance can make diagnosis and treatment of a cavernous hemangioma of the nasopharynx difficult. The nasal endoscopic technique proved to be reliable in terms of adequate exposure and visualization of the lesion, control of bleeding, and complete removal of the mass.

Primary intraosseous cavernous hemangioma of the clivus: case report and review of the literature

Primary intraosseous hemangiomas are benign, vascular malformations that account for approximately 1% of all primary bone neoplasms. These tumors are mostly found in vertebral bodies and are rarely seen in the calvarium, where they represent 0.2% of bony neoplasms. When found in the skull, they tend to present with vague symptoms and do not have the typical radiological findings suggestive of hemangiomas. Because of this, these tumors can be missed in many cases or may be misinterpreted as more ominous lesions like multiple myeloma or osteosarcoma. Involvement of the skull base is exceedingly rare, and presentation with cranial nerve unilateral polyneuropathies has not been reported. We report a patient case with review of recent pertinent literature.

Intraosseous cavernous angioma of the petrous bone

OBJECTIVE

Intraosseous cavernous angioma (CA) of the petrous bone is rare and preoperative diagnosis can be challenging, especially when its epicenter is outside the internal auditory canal (IAC) or geniculate ganglion.

METHODS

A 45-year-old man presented to our clinic with right-sided hearing loss, tinnitus, and unsteadiness. Neuroimaging revealed a right posterior petrous mass. Aggressive subtotal resection with decompression of the IAC was achieved through a right suboccipital craniotomy. Histopathological findings were consistent with CA.

CONCLUSION

As was the case with this patient, we believe that CA should be included in the differential diagnosis of petrous region pathology with bony involvement. Surgery is warranted due to its expansive nature and to decompress the adjacent neural structures.

MRI and preoperative embolization of a nasal cavity haemangioma in a child

Haemangiomas are common benign tumours of the head and neck region in children. The nasal cavity, however, is an extremely rare site for such lesions in childhood. We present the typical MRI features of a nasal cavity haemangioma in a 12-year-old girl. Biopsy was avoided because of the MRI diagnosis and preoperative embolization of the mass was performed.

Primary Intraosseous Skull Base Cavernous Hemangioma: Case Report

Primary intraosseous cavernous hemangiomas (PICHs) of the skull base are extremely rare tumors. These lesions are most common in the frontal and parietal bones of the calvarium. The authors describe a 40-year-old female who presented with progressive headaches. Serial imaging revealed a contrast-enhancing intraosseous lesion of the lateral body of the sphenoid bone and the greater wing associated with encroachment of the inferior cavernous sinus and mild posterior displacement of the cavernous carotid artery. Follow-up imaging 9 years later revealed slow growth of the lesion. The patient underwent complete excision of the PICH through an extradural frontopolar approach. Pathological examination revealed an intraosseous cavernous hemangioma. PICHs of the skull base can mimic other more common skull base lesions and thus can be difficult to diagnose preoperatively. Diagnosis is usually made at surgery. The authors review the literature regarding the clinical presentation, radiological characteristics, pathological features, and surgical management of PICHs.

The Safety and Effectiveness of the Le Fort I Approach to Removing Central Skull Base Lesions

The difficulty of gaining access to the central skull base has led to the development of many surgical approaches to this area during the past decade. Yet we believe that the Le Fort I technique, which has been used for almost 140 years in orthognathic surgery, is still an excellent approach to treating anterior skull base lesions. This procedure, which entails the horizontal sectioning of the dentoalveolar maxillary segment, seemed to fall out of favor with otolaryngologists after a few reports of complications surfaced during the past 10 to 15 years. In this article, we report a series of seven patients whom we treated with a Le Fort I approach during a 3-year period for a variety of benign and malignant anterior skull base lesions. We have encountered no significant complications of surgery or recurrence of disease at a maximum postoperative followup of 3 years.