Case report: neonatal giant forehead hemangiopericytoma with a 5-year follow-up

RATIONALE

Hemangiopericytoma (HPC) is a rare pediatric neoplasm with a high risk of bleeding, aggressive growth and high early relapse rates. Surgical excision remains the mainstream treatment, while the functions of chemotherapy and radiotherapy remain controversial. In particular, an infantile giant extracranial HPC located in the forehead has never been reported.

PATIENT CONCERNS

A 3-day-old girl was delivered normally with a giant tumor localized mainly in the right frontal region. The surface of the mass was filled with vascularity.

DIAGNOSIS

According to the results of imaging and pathological examinations, the diagnosis was HPC grade II.

INTERVENTIONS

Gross total resection of the tumor and the invading partial frontal bone followed by skin scalp reconstruction was carried out without any blood transfusion.

OUTCOMES

No recurrence was identified during 5 years of follow-up. And better outcomes can be achieved without adjuvant therapy.

LESSONS

Multimodality imaging and a collaborative multidisciplinary approach are indispensable for the successful surgical management of infantile HPC, especially for giant tumors and their potential risk of life-threatening bleeding. Gross total resection is the optimal option for infantile HPC, and even without adjuvant therapy, it achieves better outcomes.

[Urinary tract hemangiopericytoma treated with radical surgery and neoadjuvant chemotherapy. Report of two cases.]

OBJECTIVE

Hemangiopericytoma is a tumor of vascular origin. It is very rare in the prostate. They are generally aggressive tumors. Currently, the treatment of choice is radical surgery. In the literature, there are less than 50 cases described, and neoadjuvant treatment has not been reported in any article. This treatment presents positive responses in another type of sarcomas. Our goal is to report two cases of malignant hemangiopericytoma. The first case was treated with radical surgery and the second case was treated with neoadjuvant chemotherapy before surgery.

METHODS

The first case is a 40 year old male. Obstructive urinary symptoms were his first symptoms. A prostate mass with tumor characteristics was seen on ultrasound. After transrectal biopsy, he was diagnosed with hemangiopericitoma. Because the tumor size, neoadjuvant chemotherapeutic prior to radical surgery was decided. The second case is a 77 year old male with an incidental diagnosis of renal mass. After radical nephrectomy, he was diagnosed with hemangiopericitoma. He did not receive adjuvant chemotherapy.

RESULTS

In the first case, after neoadjuvant therapy, tumor size was reduced significantly. A pelvic exenteration with radical cystoprostatectomy and rectal resection and Bricker type urinary diversion and colostomy were carried out. In the second case controls after radical nephrectomy were correct and he did not need any treatment.

CONCLUSIONS

In urinary tumors, the prostate hemangiopericytoma is a rare entity. Currently, neoadjuvant chemotherapy is not established as treatment for these tumors. For other sarcomas neoadyuvant treatment has good response. In our case, a good result was obtained with neoadjuvant chemotheraphy before surgery. However, a greater number of cases are necessary to establish the use of neoadjuvant chemotherapy in urinary hemangiopericytomas.

Hemangiopericytoma/Solitary Fibrous Tumor in the central nervous system. Experience with surgery and radiotherapy as a complementary treatment: A 10-year analysis of a heterogeneous series in a single tertiary center

Hemangiopericytoma and Solitary Fibrous Tumor are tumors with low incidence. They have a tendency to recur locally and to metastasize. The WHO integrated both tumors into a new entity but one of the pending issues is to demonstrate the effectiveness of surgery plus complementary radiotherapy (RT) and standardize the use of it. We reviewed the data from 10 years. We assessed pathologic and radiologic characteristics. The operation records were evaluated to determine the features and extent of tumor resection. We compared the outcomes in patients using or not RT. The mean follow-up was 74.8 months, with a range of 12 and 210 months. The population included 3 males (30%) and 7 females (70%). The most common location was brain convexity (30%), the remaining were cervical and lumbar spine, sacrum, intraventricular, torcular, sphenoid ridge and intraorbital. Postoperative external beam radiotherapy was delivered in 7 patients (70%), the criteria were a partial resection or WHO II and III histological grades. 2 patients developed local recurrences at 12 and 19 months after initial surgery. 1 patient underwent 2 surgeries, and the other, 4 surgeries. The mean recurrence free survival rate was 15.5 months. Distant metastases were found in 4 patients. 3 of the 10 patients died. Five-year overall survival rate was 66% and mean overall survival was 76 months. A safe and complete resection in the first surgery is the most important prognostic factor. Complementary RT can be helpful, even in cases of complete resection in WHO low-grade.

Spinal location is prognostic of survival for solitary-fibrous tumor/hemangiopericytoma of the central nervous system

BACKGROUND

Prior studies have highlighted infratentorial tumor location as a prognostic factor for solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) of the central nervous system (CNS), and spinal location is considered a positive prognostic factor for other tumors of the CNS. While SFT/HPC of the CNS is known to frequently arise from the spinal meninges, there are no case series that report outcomes for spinally located CNS tumors, and their prognosis in relation to intracranial and other CNS-located tumors is unknown.

OBJECTIVE

To investigate outcomes for patients with SFT/HPC of the spinal meninges.

METHODS

The Surveillance, Epidemiology, and End-Results Program was used to identify patients with SFT/HPC within the CNS from 1993-2015. We retrospectively analyzed the relationship between tumor location (spinal vs. Brain and other CNS) and survival.

RESULTS

We identified 551 cases of CNS SFT/HPC, 64 (11.6%) of which were primary tumors of the spinal meninges. Spinal tumors were more likely than brain and other CNS tumors to be SFT vs. HPC (37.5 vs. 12%, p < 0.001), benign (42.2 vs. 20.3%, p < 0.001), and less than 5 cm (53.1 vs. 35.7%, p < 0.001). The 10-year survival rates for spinal and brain/other CNS tumors were 85 and 58%, respectively. Median survival time was significantly longer for spinal tumors (median survival not reached vs. 138 months, p = 0.03, HR = 0.41 [95% CI 0.18-0.94]). On multivariable analysis, spinal tumor location was associated with improved survival over tumors located in the brain and other CNS (HR = 0.36 [95% CI 0.15-0.89], p = 0.03).

CONCLUSION

Spinal tumor location is associated with improved survival in patients with SFT/HPC of the CNS. Larger institutional studies are necessary to characterize the relationship between tumor location and other relevant factors such as presentation and amenability to gross-total resection and adjuvant radiotherapy. Future studies exploring optimal management of spinally located tumors are also needed.

Leksell Radiosurgery for the 3 H Tumors: Hemangiomas, Hemangioblastomas, and Hemangiopericytomas

Leksell stereotactic radiosurgery has proven to be effective for less common tumors encountered in the brain, including hemangiomas of the orbit or cavernous sinus, recurrent hemangiopericytomas, and both sporadic hemangioblastomas as well as those encountered in the context of von Hippel-Lindau (VHL) disease. While all three tumors are responsive to single-session radiosurgery, hemangiomas and hemangiopericytomas are the most likely to demonstrate tumor regression. Hemangiopericytomas that recur after initial resection can be lower grade or anaplastic and have both higher local as well as distant recurrence risks. Sporadic hemangioblastomas undergo Leksell radiosurgery at the time of recurrence after initial surgery. In the context of VHL, growing or recurrent tumors are treated with tumor control rates exceeding 90%. Tumor control improves with higher dose delivery, typically >15 Gy at the margin. Dose-limiting structures may include the optic apparatus for hemangiomas and brain stem locations for hemangioblastomas.

Sinonasal hemangiopericytoma caused hypophosphatemic osteomalacia: A case report

RATIONALE

Tumor-induced osteomalacia (TIO) is a rare, paraneoplastic syndrome featured with fibroblast growth factor 23 (FGF23) secretion primarily by benign mesenchymal tumors and sometimes by malignancies. TIO diagnosis and treatment is often delayed because TIO usually has nonspecific generalized bone pain and weakness, and location of TIO tumor is quite challenging. Very few TIO caused by sinonasal hemangiopericytoma have been reported in the literature.

PATIENT CONCERNS

A 40-year-old Chinese woman presented with diffuse bone pain for more than 1 year. Laboratory examination showed hypophosphatemia, hyperphosphaturia, hypocalcemia, an elevated serum alkaline phosphatase (ALP) level and bone-specific ALP level. Imaging studies revealed low bone mineral density (BMD) and multiple pseudofractures at the ribs. F-18 fluorodeoxyglucose positron emission tomography was negative in searching for tumors. Because no tumor was located, the patient was treated with oral phosphate, calcium, and alfacalcidol, and achieved great relief in her symptoms and improvement in BMD. Six years later, the patient had breast cancer surgery and received chemotherapy, and still had hypophosphatemia. During this time, nasopharyngo-fiberscope showed nasal mass in her left nasal cavity. Then she had her nasal polyps removed and surprisingly the serum phosphate became normal.

DIAGNOSES AND INTERVENTIONS

The patient had the nasal mass resected, and pathological diagnosis of the nasal mass was sinonasal hemangiopericytoma. Immunohistochemical analysis was positive for FGF23. Thus the final diagnosis was osteomalacia induced by sinonasal hemangiopericytoma. Phosphate supplementation and alfacalcidol were discontinued.

OUTCOMES

The patient had normal serum phosphate after 6-month follow-up.

LESSONS

By presenting this case, we hope to remind clinicians that in patients with osteomalacia with undetermined reason and intranasal polypoid mass, sinonasal hemangiopericytoma should be suspected.

Clinical outcomes of intracranial solitary fibrous tumor and hemangiopericytoma: analysis according to the 2016 WHO classification of central nervous system tumors

OBJECTIVEThe authors conducted this retrospective study to investigate the clinical outcomes of intracranial solitary fibrous tumor (SFT) and hemangiopericytoma (HPC), defined according to the 2016 WHO classification of central nervous system (CNS) tumors.METHODSHistopathologically proven intracranial SFT and HPC cases treated in the period from June 1996 to September 2014 were retrospectively reviewed and analyzed. Two neuropathologists reviewed pathological slides and regraded the specimens according to the 2016 WHO classification. Factors associated with progression-free survival (PFS) and overall survival (OS) were statistically evaluated with uni- and multivariate analyses.RESULTSThe records of 47 patients-10 with SFT, 33 with HPC, and 4 with anaplastic HPC-were reviewed. A malignant transition from conventional SFT to WHO grade III SFT/HPC was observed in 2 cases, and 13 HPC cases were assigned grade III SFT/HPC. Mean and median follow-ups were 114.6 and 94.7 months, respectively (range 7.1-366.7 months). Gross-total resection (GTR) was significantly associated with longer PFS and OS (p = 0.012 for both), and adjuvant radiation therapy versus no such therapy led to significantly longer PFS (p = 0.018). Extracranial metastases to the liver, bone, lung, spine, and kidney occurred in 10 patients (21.3%). Grade III SFT/HPC was strongly correlated with the development of extracranial metastases (p = 0.031).CONCLUSIONSThe 2016 WHO classification of CNS tumors reflected the different types of pathological malignant progression and clinical outcomes better than prior classifications. Gross-total resection should be the primary treatment goal in patients with SFT/HPC, regardless of the pathological grade, and radiation can be administered as adjuvant therapy for patients with SFT/HPC that shows an aggressive phenotype or that is not treated with GTR.

Real-time intraoperative contrast-enhanced ultrasound (CEUS) in vascularized spinal tumors: a technical note

BACKGROUNDS

Intra-operative ultrasound (ioUS), and the recently introduced contrast-enhanced ultrasound (CEUS) demonstrated to be an extremely valuable tool in oncological cerebral neurosurgery.

METHODS

The authors applied ioUS/CEUS techniques to spinal oncological surgery as showed in the illustrative case of a dorsal hemangiopericytoma.

RESULTS AND CONCLUSIONS

ioUS and CEUS provide real-time information that proved useful in identifying both vascular and parenchymatous tumoral patterns, anatomical relations with nervous structure, plan surgical strategy, and identify residuals. It allows to visualize unexposed anatomical and pathological structures within the parenchyma and is a valuable guide during resection.

Diagnosis and treatment of solitary fibrous tumor/hemangiopericytoma of central nervous system. Retrospective report of 17 patients and literature review

To investigate the diagnosis, treatment and prognosis of solitary fibrous tumor (SFT)/ hemangiopericytoma (HPC) of central nervous system (CNS), we retrospectively reviewed records of 17 patients who were treated for CNS SFT/HPC at the Department of Neurosurgery, China-Japan Union Hospital of Jilin University from December 2010 to June 2016, and reevaluated their pathological diagnoses according to the 2016 WHO classification of CNS tumors. We then analyzed their clinical symptoms, imaging characteristics, treatments and outcomes. Clinical manifestations of CNS SFT/HPC were diverse, but mainly included headache, increased intracranial pressure, seizures, and focal neurological deficits. In MRI, CNS SFT/HPC usually shows heterogeneous signals, and unusual enhancements; we saw lobulated shapes in 13 patients and necrotic or cystic changes in 12 patients. Tumors of all 17 patients were resected surgically; 9 patients also received postoperative adjuvant radiotherapy. Mean follow-up time was 21 months (range: 2-67 months). The 17 surgeries included 11 total resections, 4 subtotal resection, and 2 partial resections. We followed up 12 patients; 9 of the patients who received total resections had no disease progression; among the 6 patients who did not receive total resections, 2 died of tumor recurrence, 1 has not shown any disease progression. Thus, extent of resection has an apparently crucial influence on prognosis. Postoperative radiotherapy should be chosen carefully, based on resection extent and pathologic grade.

Recurrent Intracranial Hemangiopericytoma with Extracranial and Unusual Multiple Metastases: Case Report and Review of the Literature

Hemangiopericytoma is a rare tumor with uncommon location in the central nervous system. It has only recently been included (WHO classification 1993) in a specific group of CNS tumors and subsequently (WHO classification 1997 and 2000) as a group by itself, while before it was confused with meningeal tumors. We report on a case of a 48-year-old woman affected by this tumor. The neoplasm was located in the posterior fossa. The patient underwent primary surgery in 1990, not followed by any adjuvant therapy because of the histopathological diagnosis of meningioma. After being free from disease for eight years she developed a local recurrence in 1998. Subtotal excision of the tumor, which was finally identified as a hemangiopericytoma, was carried out, followed by adjuvant radiotherapy (64 Gy). After six months multiple metastases were found in the liver and right kidney. A radical metastasectomy was performed, followed by systemic chemotherapy. One year later (2001) the tumor recurred again intracranially and a metastases was detected in the right breast, so the patient again underwent cranial irradiation (40 Gy) and second-line chemotherapy. She died in September 2002, 12 years after the diagnosis. We may conclude that, despite the tumor's natural tendency to recur several times and the ability of intracranial hemangiopericytoma to spread outside the CNS, it is possible to ensure a long survival time.

Extrapleural Pneumonectomy for Sarcomas Report of two Cases

Aims and background

Extrapleural pneumonectomy (EPP), which is a very uncommon surgical procedure, is electively indicated only in patients with early stages of malignant pleural mesothelioma, a rare condition. Two adults suffering from sarcomas and treated with EPP are described here.

Methods

A 29-year-old male with four left-sided lung metastases and ipsilateral pleural effusion from a chondrosarcoma of the mandibula and a 64-year old woman with a megamass in the left chest due to a local recurrence of a hemangiopericytoma underwent EPP.

Results

Extra-EPP-field multiorgan progression was diagnosed 14 months following surgery in the first patient who died at the 24th postoperative month but remained free of disease at the site of surgery. The second patient had a chest wall relapse at the forty-third month following EPP, which was treated by partial resection of the second and third ribs. She is alive and disease-free at the twelfth postoperative month.

Discussion

EPP may be considered for salvage treatment in selected patients with intrathoracic sarcomas not amenable to other effective therapies to achieve mid- to long-term disease control, even in the case of advanced spread.

Primary malignant myopericytoma with cancer cachexia: Report of the first case and review of literature

RATIONALE

Malignant myopericytoma is extremely rare, with a few cases described in the English literature.

PATIENT CONCERNS

This novel study aimed to report a case of malignant myopericytoma with cancer cachexia arising in the left armpit. Also, it presented a review of the English literature regarding primary malignant myopericytoma, aiming to clarify the clinical features and potentially curative treatment. A 56-year-old male presented with an ulcerated and smelly mass involving her left armpit. The patient had obvious symptoms of cancer cachexia, including emaciation, anemia, and lower extremity edema.

DIAGNOSES

Computer tomography (CT) scan demonstrated a mass in the left armpit, with no evidence of metastasis according to the chest CT, abdominal ultrasound, and emission CT. The patient underwent a core biopsy of the mass, and a diagnosis of malignant myopericytoma was rendered.

INTERVENTIONS

He received 2 standard courses of theprubicin combined with ifosfamide chemotherapy regimen with no tumor response. Then, he subsequently underwent complete excision of the tumor.

OUTCOMES

The symptoms of cancer cachexia disappeared gradually after operation. Recurrence and metastasis were not shown during follow-up for 5 years.

LESSONS

Myopericytoma are generally considered benign with an indolent clinical course, and a few reports have described malignant myopericytoma in the literature. No standard treatment is available, and complete surgical excision of the lesion may be the only potentially curative treatment. The efficacy of chemotherapy and radiation is uncertain.

Sellar and Suprasellar Anaplastic Hemangiopericytoma in a 34-Year Old Man

Central nervous system hemangiopericytomas are rare, representing <1% of all primary central nervous system tumors. Hemangiopericytomas of the sellar region are exceptionally rare. Here we present a case of a sellar/suprasellar anaplastic hemangiopericytoma.The patient is a 34 year old man with a history of a resected pituitary tumor, diagnosed as a pituitary adenoma per the patient, who presented with bitemporal hemianopsia. Radiology revealed a 3.7 cm enhancing sellar/suprasellar mass with local mass effect, consistent with a pituitary adenoma. On resection, the mass was diagnosed as anaplastic hemangiopericytoma, WHO grade III. The patient experienced residual tumor with two further resections before expiring of a pulmonary embolus seven months later.There are only 10 previously documented cases of sellar/suprasellar hemangiopericytoma in the English-speaking world literature. This is the third case of anaplastic hemangiopericytoma in this region. These cases should be recorded until meaningful conclusions about therapy and prognosis can be established.

Haemangiopericytoma-like tumor of the nasal cavity treated by endoscopy - a case report

Haemangiopericytoma (HPC) is an uncommon, vascular tumor derived from Zimmerman pericytes surrounding blood vessels. HPC constitute around 1% of all tumors of vascular origin and may appear anywhere, 5% of them can be situated in nasal cavity. Tumor location within the head and neck predispose to its benign character and improves prognosis. This case report presents the case of 33-year-old patient with haemangiopericytoma-like tumor of the nasal cavity, presented symptoms of impaired nasal breathing and recurrent epistaxis. Tumor was excised with 0 degree endoscope. The follow-up recurrence-free period was 2 year 6 months and shows this is effective way of treatment. Described in the literature late recurrences and metastases reminds that regular, life-long observation is mandatory.

Myopericytoma around the knee: mimicking a neurogenic tumour

Myopericytoma is a rare, usually benign soft tissue tumour that arises most commonly in the dermis and subcutaneous soft tissue of the lower extremities. In this article, we present an unusual case of myopericytoma occurring in the deep soft tissue around the knee that mimicked a neurogenic tumour. Myopericytoma can be confused with neurogenic tumour when located in deep soft tissue and adjacent to nerve bundles. Preoperative MRI and colour Doppler ultrasound may help differentiate myopericytoma from neurogenic tumour by revealing the hypervascular nature of the tumour.

Retroperitoneal Hemangiopericytoma in a young woman. Case report and literature review

Hemangiopericytoma (HPC) is a primary tumor with mesenchymal vascular origin that represents 1% of all vascular neoplasm. HPC develops from the Zimmerman's pericytes around capillaries venules and it is possible to observe it frequently in the extremities, pelvis, retroperitoneum, head, neck and meninges. The only definitive parameter of malignancy is the development of recurrence or distant metastases. This report describes a case of symptomatic retroperitoneal HPC in a young female patient treated by surgical complete removal of the mass, and literature review. Despite the relatively simple surgical management of retroperitoneal Hemangiopericytoma, its diagnosis still remains difficult and often is incidentally. Patients should undergo a close long-term follow up, by periodic CT scan, due to the high probability of local recurrence or distant metastases that can occur also many years after surgery.

KEY WORDS

Hemangiopericytoma (HPC), Retroperitoneum, Surgery.

Osteoplastic Maxillotomy for Treatment of Neoplasms of the Nasopharynx and Infratemporal Fossa

Approaches to the infratemporal fossa and nasopharynx are difficult because of the anatomic complexity of these regions. We describe our experience with osteoplastic maxillotomy, with our own modifications, and evaluate oncological outcomes and postoperative quality of life. Ten patients underwent osteoplastic maxillotomy, 3 of whom had a diagnosis of malignancy, and 7 of whom had nasopharyngeal angiofibromas (NPAs). A Weber-Fergusson incision was made to develop facial flaps and preserve the vascularity of the maxilla. Osteotomies were performed through the facial aspects of the maxilla, on the orbital rims, and on the malar eminence for the medial variant of the procedure. The anterolateral variant involved descent of the temporalis muscle with preservation of the facial nerve, and a zygomatic osteotomy. Four craniotomies were done. Two patients had the medial variant of the procedure, and 8 had the anterolateral variant. The complications were transient and mild. The patients who had malignancies are alive with no disease, and there was 1 recurrence among the 7 patients with NPAs. We found excellent aesthetic results in 8 of the 10 patients, and no change in basic functions in 8 patients. Osteoplastic maxillotomy allows resection of massive NPAs with no significant bleeding. Resection of malignant lesions with good results is feasible.

Hemangiopericytoma in the Eyelid of a Horse

Hemangiopericytoma (HP) is a well-recognized neoplasm arising from vascular pericytes that has been reported only in the dog and man. In this study, we describe a 14-year-old female Arabian horse that was presented for surgical excision of a 2-cm-diameter expansile subcuticular mass in the right lower eyelid. Histologically, the mass consisted of loosely arranged interlacing streams and storiform bundles of spindle cells that often formed distinct whorls around a central capillary and bundles of collagen (Antoni A-like pattern). Immunohistochemical analysis revealed strong diffuse cytoplasmic immunoreactivity for vimentin and focal immunoreactivity for smooth muscle actin, whereas neoplastic cells did not stain for Factor VIII-related antigen, Glial fibrillary acidic protein (GFAP), or S100. On the basis of histomorphology and immunohistochemical reactivity, the present tumor was diagnosed as HP. To our knowledge, this is the first report describing a HP in a horse.

[Rib Metastasis from Intracranial Hemangiopericytoma: Report of a Case]

A 65-year-old man had undergone the surgical treatment for intracranial hemangiopericytoma(HPC) in 2011. In June 2013, the X-ray abnormality in health examination was pointed out. Chest Computed tomography shows a 30 mm-sized tumor lesion with bone destruction in the 6th left rib bone. Fluorodeoxyglucose-positron emission tomography revealed no lesion except for the tumor. Surgical resection of the rib tumor was performed in July 2013. Pathologically it was diagnosed as bone metastasis of HPC. The postoperative course was uneventful, but multiple bone metastases were found 6 months after surgery.

Myopericytoma tumor of the glans penis

Myopericytoma is a low grade spindle cell neoplasm largely occurring in skin. We describe the first reported case of a penile myopericytoma. Histologically, the penile tumor was composed of a perivascular proliferation of tumor cells with ovoid shaped nuclei and abundant eosinophilic cytoplasm. Immunohistochemically, the tumor was reactive for markers of smooth muscle differentiation and vascular differentiation. The tumor was noted to be negative for BRAF by immunohistochemistry and wild-type upon gene sequencing using SnaPshot. Our finding serves to expand the anatomical distribution of myopericytoma and broadens the spectrum of primary mesenchymal neoplasms that may be encountered in the penis.

Renal myopericytoma: a clinicopathologic study of six cases and review of the literature

To evaluate the morphologic features, immunohistochemical profiles, and biological behavior of renal myopericytoma. Six cases of renal myopericytoma are retrospectively retrieved and analyzed by H&E and immunohistochemical staining. Clinically, patient's age ranged from 33 to 70 years (median, 56 years). Male to female ratio was 5:1. Five of the six patients were asymptomatic of the urinary tract, the remained one presented with abdomen pain. Grossly, all six tumors were solitary masses with sizes ranging from 1.8 to 7.3 cm of maximum diameter (mean, 4.4 cm). Five tumors were described as well-circumscribed, and 1 case was showed as ill-defined. Histologically, in all cases, numerous thin-walled vessels and a perivascular arrangement of ovoid, spindled or round myoid tumor cells were seen. However, a broad morphologic spectrum ranging from fibroma-like (3 cases), glomangiopericytoma-like (3 cases), angioleiomyoma-like (2 cases), glomoid- like (2 cases), and myofibroma-like (2 cases) components were observed. In addition, 1 neoplasm with immature cellular features and another infiltrating myopericytoma were found. A coexisting papillary adenoma was detected in 1 case. Nuclear atypia was seen in 2 cases. Immunohistochemically, SMA, caldesmon, and MSA were positive in all 6 cases, whereas CD34 and desmin was partial positive in 1 case, respectively. Ki67 index was aproximately 5% in 1 case but less than 2% in the others. All patients are free of disease by follow-up ranging from 14 to 66 months (mean, 38.7 months).

Sinonasal haemangiopericytoma: histomorphology and differential diagnoses

A 39-year-old female presented with a fleshy nasal polyp occluding the left nasal cavity, associated with haemopurulent discharge. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans of the paranasal cavities revealed a large polypoid tumour arising from the left middle turbinate and obstructing the left maxillary sinus ostium. However, no bony or intracranial involvement was identified. A biopsy revealed a tumour with small blue round cell morphology. The tumour cells showed diffuse strong membranous CD99 positivity and patchy CD34 positivity. Ancillary cytogenetic tests for the EWSR1 and SS18/SYT gene translocations were negative. In view of the non-invasive nature of the tumour and the low cell proliferative index (Ki-67) of 5%, a medial maxillectomy resection was performed. The resection revealed additional areas with spindle-cell morphology and focal haemangiopericytic vasculature. The tumour continued to show immunoreactivity to CD99 and CD34, as well as Smooth Muscle Actin (SMA) and Muscle Specific Actin (MSA). The overall findings are in keeping with a sinonasal haemangiopericytoma. With clear surgical resection margins, the patient is on routine follow-up and is currently disease-free.