Hemangiopericytoma Of Nasal Cavity: Review of the Literature and Report of Three Cases

Management of sinonasal hemangiopericytomas: a systematic review

BACKGROUND

Hemangiopericytomas are typically found in soft-tissue, but only rarely found in the sinonasal tract. Sinonasal hemangiopericytomas have been reported mostly through case studies, and optimal treatment is considered surgical excision. Classically, open surgical methods of tumor extirpation have been considered standard of care. With the wider use of endoscopic methods, an updated systematic review in terms of treatment is warranted.

METHODS

Cases were identified using a MEDLINE and PubMed search. Relevant studies were identified, and data was extracted regarding patient demographics, presenting symptoms, tumor characteristics, treatment, and outcomes.

RESULTS

A total of 128 cases were collected from 56 articles, consisting of case reports and series. The most common presenting symptoms were epistaxis, nasal obstruction, and facial pain/swelling/pressure. Computed tomography (CT) and X-ray were the most common modes of imaging during diagnosis and operative planning. The tumor often occupied multiple locations in the sinonasal tract at initial presentation. Surgical resection was the mainstay of treatment in 126 of the 128 cases (98.4%), either through open resection or endoscopic techniques. Surgical removal resulted in no recurrence in 79.7% of the cases. The use of endoscopic techniques increased significantly in the past decade. This review found no significant difference in terms of recurrence between endoscopic and open treatment groups, age, gender, and unilocality vs multilocality of tumor.

CONCLUSION

Surgical management remains the mainstay of treatment for hemangiopericytomas. Endoscopic resection of these lesions has increased over the last few decades and has become a safe, viable, and reasonable alternative to open resection.

Systematic review of treatment and prognosis of sinonasal hemangiopericytoma

BACKGROUND

This study was undertaken to determine the recurrence rate for open and endoscopic surgery and the clinical prognosis of this sinonasal tumor.

METHODS

A systematic review of individual cases of sinonasal hemangiopericytoma was performed. A total of 97 articles were included in the study and reviewed to extract the relevant information about each case.

RESULTS

In all, 194 cases of sinonasal hemangiopericytoma were identified. There were 53 recurrences (27.3%), 6 tumor-related deaths (3.1%), and 4 cases of metastases (2.1%). There was no significant difference between rate of recurrence for endoscopic or open resection (p = .06). Incomplete excision was the most important predictor of recurrence (odds ratio = 11.50, 95% confidence interval 3.76-36.82, p < .001). Radiotherapy may be advantageous in cases of incomplete surgical resection (p = .03).

CONCLUSIONS

Complete excision is essential to minimize tumor recurrence and radiotherapy may decrease the rate of recurrence in the case of incomplete resection. Current evidence does not suggest that open resection is superior to endoscopic resection.

An immunohistochemical study of sinonasal hemangiopericytoma

We present herein the imaging and pathological features of a 28-year-old male with a sinonasal hemangiopericytoma-like tumor occupying the left nasal meatus. At the initial visit, a nasal polyp was suspected, but, as the patient was bleeding readily, an angiomatoid lesion was also regarded as a possible diagnosis. Based on a thorough histopathological analysis, a sinonasal hemangiopericytoma-like tumor was diagnosed. Hematoxylin and eosin staining also showed a mild degree of nuclear pleomorphism and a slight increase in mitotic activity, and immunohistochemical studies using anti-CD34, MIB-1, and Vimentin antibodies were useful for distinguishing the hemangiopericytoma-like tumor from true hemangiopericytoma and a solitary fibrous tumor.

Hemangiopericytoma of the head and neck

PURPOSE

To report a series of patients with hemangiopericytoma (HP) of the head and neck, to review pathological features of these tumors, and to discuss management options.

MATERIALS AND METHODS

A retrospective review of the medical records at the University of California, Los Angeles (UCLA) Medical Center in Los Angeles, CA, was done in order to identify those patients with primary HP of the head and neck, including soft tissue and mucosal sites.

RESULTS

Ten patients with HP of the head and neck were identified. There was an equal sex distribution and an average age of 36 (range 10-65). Seven of the tumors arose from soft tissue sites in the head and neck, and the remaining 3 arose from the mucosa. All patients underwent wide excision of the primary lesion with a local recurrence rate of 40%. Thirty percent of patients developed metastatic lung disease 0 to 8 years after initial diagnosis. Each patient who developed metastatic disease had abundant mitoses on pathological review compared with rare or absent mitoses in the lesions that took a more benign course.

CONCLUSIONS

Pathological appearance of resected HP is predictive of later metastatic potential. Long-term follow-up is necessary in patients even after radical resection because recurrence or metastasis may be delayed by many years.

Sinonasal hemangiopericytomas: a clinicopathologic and immunohistochemical study of seven cases

BACKGROUND

Sinonasal hemangiopericytoma (SNHPC) is a rare lesion usually of low-grade malignant potential. Aggressive and metastatic cases are uncommon, and experience using adjuvant therapy on these cases has been limited. Tumor-induced osteomalacia has a very rare association with SNHPC. Further, the diagnosis of SNHPC remains one of histologic-pattern recognition. Traditionally, immunohistochemistry has aided in excluding other diagnoses; only vimentin has been consistently expressed by the tumor spindle cells of HPC. Recent studies have shown that Factor XIIIa is also expressed by HPC, (as well as tumors of fibrohistiocytic differentiation) and hence may be yet another helpful positive marker in establishing an immunohistochemical profile.

METHODS

We identified 7 patients at this institution with SNHPC from 1990 to 1994. Immunohistochemistry was performed on seven formalin-fixed paraffin-embedded tumors utilizing antibodies to factor XIIIa as well as antibodies to vimentin, factor VIII, muscle-specific antigen, cytokeratin, and S-100.

RESULTS

All 7 patients were initially seen with nasal obstruction or epistaxis and underwent surgical resection. The period of follow-up was from 3 months to 14 years (mean 54 months) for 7 patients. Three patients had recurrent disease after 3, 5, and 10 years. The first 2 were known to have been originally treated by polypectomy. One patient required adjuvant radiotherapy for metastatic disease and local extension. One patient was initially seen with tumor-induced osteomalacia which dramatically improved following resection of the lesion. The immunohistochemical profile revealed strong expression of vimentin in 7/7 cases, and of factor XIIIa in 4/7 cases; tumor cells did not express the other markers studied.

CONCLUSIONS

Adequate surgical resection with negative margins appears to be the appropriate therapy for SNHPC. Our 1 case associated with tumor-induced osteomalacia was reversible after surgical excision of the tumor. The immunohistochemical results suggest that the pattern of vimentin and factor XIIIa positivity, as well as lack of expression of other markers, is consistent with the diagnosis of HPC, which still remains in the domain of histopathology.

Hemangiopericytoma of the maxillary sinus and skull base

Since 1949, only 52 cases of hemangiopericytoma (HPC) of the nose and paranasal sinuses have been reported in the literature. Of the latter, only 2 originated from the maxillary sinus. This article reports 2 new cases. One arose in the maxillary sinus and involved the pterygopalatine fossa, skull base, and infratemporal fossa. The second tumor was located in the sphenoethmoidal recess. A new combination of techniques for resection of hemangiopericytoma of the skull base is described. Prognostic criteria for such tumors are reviewed, in conjunction with histological diagnosis.

Haemangiopericytoma of the nose and paranasal sinuses

The uncertain course and rarity of haemangiopericytoma in the nose and paranasal sinuses has interested both pathologists and clinicians. This tumour arises from proliferation of pericytes which invest capillary endothelium. A benign course is more common in the nose and paranasal sinuses. The first nasal haemangiopericytoma was reported by Stout in 1949. Since then only twenty cases have been reported in the literature. We present three further cases.

Unusual polypoidal tumours of the nasal cavity: a clinicopathological review of 18 cases

A variety of nasal conditions may present as simple polypi. Clinically, these lesions, some very rare, present a diagnostic problem. Eighteen cases of unusual lesions which were thought to be simple polyps on clinical grounds are reviewed with the relevant literature. The series includes 2 olfactory neuroblastomas, a haemangiopericytoma and a basal encephalocoele. Atypical features from the history and examination are highlighted. It is emphasized that every nasal polyp must be submitted for histological examination and the pathology report consulted when the patient is reviewed. Failure to do so delays appropriate treatment.

Malignant hemangiopericytoma of the nasal cavity. Report of a case and review of the literature

Haemangiopericytoma is only rarely localized in the nasal cavity. The authors' experience with one case has prompted them to review the literature critically, in order to understand better the most appropriate diagnostic procedures and therapeutic measures.

Haemangiopericytoma in otolaryngology

Haemangiopericytoma is a rare vascular tumour with variable pathological behaviour. It arises from the proliferation of special cells called 'pericytes' which are found outside the blood capillaries. There is no specific predilection for any site in the body. Clinically and histologically, it can be benign or malignant, but this differentiation sometimes becomes rather a hard task for the pathologist. Wide surgical excision is the treatment of choice. Radiotherapy and chemotherapy can be valuable adjuncts. Only fourteen cases of nasal haemangiopericytoma have been reported in the literature and these are individually set out in Table I. Another case is reported in this paper, with a review of all the tumours in the field of Otorhinolaryngology since 1942.

The role of radiotherapy in the management of malignant hemangiopericytoma: report of eleven new cases and review of the literature

The response of hemangiopericytoma to radiation therapy was studied in 11 patients treated at Memorial Hospital. Response of greater or lesser degree was noted in 26 of 29 radiation therapy courses administered. These included 14 instances of complete tumor regression. Dose and tumor size were the main factors influencing response. The tumors tend to regress slowly and incompletely; yet effective relief of symptoms and long term local control (average duration 27 months) usually was achieved. These results and those reported by others believe the alleged inefficacy of radiation therapy in the management of these tumors. Palliative radiation therapy seems to be worthwhile even in advanced cases. Because of the high rate of local recurrence after surgical excision, treatment strategies combining local excision of large primary tumors with wide-field, high-dose radiation therapy are worthy of trial.