Angiectatic Sinonasal Polyp: A Diagnostic Challenge
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CLINICAL REPORT
Angiectatic Sinonasal Polyp: A Diagnostic Challenge P. K. Purushothaman1
•
M. Sharanya1 • S. P. Manoj Pandian1
Received: 24 August 2020 / Accepted: 31 August 2020 Ó Association of Otolaryngologists of India 2020
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. Keywords Angiectatic polyp Hemangioma Endoscopic excision Double approach
Introduction Sinonasal angiectatic or angiomatous polyp (SAP), a rare entity, comprises about 4–5% of all inflammatory sinonasal polyps [1]. Their varied presentation simulates pathologies like hemangioma, inverted papilloma, angiofibroma or malignancy [2]. Hence warrants a precise pre-operative diagnosis in order to restrain from extensive surgical procedures. This paper is regarding one such unique case that gave the impression of a cavernous hemangioma of the maxillary sinus pre-operatively, however the histopathological diagnosis of SAP was a revelation.
& P. K. Purushothaman [email protected] 1
Department of Otorhinolaryngology, SRM Medical College Hospital and Research Institute, Kattankulathur, Kancheepuram, Tamil Nadu, India
Case Report A 50-year-old male presented to the ENT OPD with leftsided nasal block since 3 years and nasal bleed for 1 year. His nasal block was insidious and gradually progressive. Nasal bleed was sudden, 3–4 unprovoked episodes of moderate bleeding. The patient denied other positive history. He was a known Diabetic and Hypertensive since 10 years, on irregular medication, and a non-smoker. Anterior rhinoscopy and diagnostic nasal endoscopy (DNE) revealed a pinkish vascular mass in the left middle meatus region, obscuring the middle turbinate and the choana. Left maxillary sinus region was tender. Contrast Enhanced Computed Tomography (CECT) scan and Magnetic Resonance Imaging (MRI) screening of the paranasal sinuses were done, suggesting a slow flow vascular malformation, most likely a Cavernous hemangioma, or less likely an expansile vascular neoplastic lesion (Fig. 1). CT-Angiography again revealed a cavernous hemangioma in the left maxillary sinus. Pre-operative embolization was done under local anaesthesia through right femoral artery approach. The feeder vessel was identified as the Sphenopalatine artery and was embolised with Fiber Nester coil to prevent recanalization. 48 h post-embolization, patient was subjected to transnasal endoscopic surgery under general anaesthesia. Intraoperatively, mass was visualised involving the left maxillary antrum, extending via the ostium into the middle meatus and descending towards the choana. It was seen indenting the inferior meatus region and eroding the medial wall of the maxilla. The bone around this dehiscent region was drilled. The tumou
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