Glomus tumor of the nasal cavity

Malignant and benign sinonasal paragangliomas

OBJECTIVES/HYPOTHESIS

To report on the clinical course and management of sinonasal paragangliomas (PGLs).

STUDY DESIGN AND METHODS

Retrospective chart review of six patients with PGLs of the nasal cavity and paranasal sinuses.

RESULTS

Three patients had tumors with malignant clinical behavior with cerebral metastases or infiltration of brain and local recurrence, despite surgery and/or radiotherapy, while three patients demonstrated a benign course.

CONCLUSION

Sinonasal paragangliomas are frequently malignant. If malignant, they are very aggressive, with rapid local spread as well as high metastatic potential despite surgical resection; and they have a poor prognosis. Malignancy cannot be diagnosed on histology, but only on the basis of clinical behavior. Intracranial metastasis is commonly expected. Long-term follow-up, with particular emphasis put on the intracranial structures, is mandatory as recurrences or metastasis may occur even after a long time interval.

Paraganglioma of the sphenoid sinus: case report and review of literature

We report a case of a 41-year-old woman who presented with occasional hemoptysis and hoarseness. Imaging showed a mass primarily in the sphenoid sinus but also extending into the right posterior ethmoid sinus and nasopharynx. Histology showed this mass to be a paraganglioma. We describe its computed tomography and magnetic resonance imaging findings, and we discuss the differential diagnosis and treatment.

Paraganglioma of the nasal cavity: a case report

We describe the case of a 72-year-old woman presenting with a 1-year history of recurrent epistaxis and unilateral progressive nasal obstruction with associated rhinolalia resulting from the presence of a tumor mass occupying two-thirds of the right nasal cavity. Histopathologically, neoplastic cells or "chief cells" were arranged in well-defined nests, which had the classic alveolar or so-called "zellballen" pattern. Immunohistochemical studies highlighted the presence of S-100 protein-positive sustentacular cells located at the periphery of the clusters of chief cells. The chief cells showed a diffuse and intense positivity for neuron-specific enolase and synaptophysin. A diagnosis of paraganglioma was made. The lesion was excised completely and the patient did not develop recurrences or distant metastases after 8 months of follow-up. Paragangliomas arising in the nasal cavity and paranasal sinuses are extremely rare tumors. We report on the clinical, histopathological and immunohistochemical findings of our case and review the cases previously described in the literature.

Laryngeal and sinonasal paragangliomas

Laryngeal paragangliomas are classified as supraglottic and infraglottic. This article defines each type of paraganglioma, discusses the clinical features and diagnoses, and covers the surgical management. This article also addresses sinonasal paragangliomas, including their clinical features, diagnosis, and treatment.

Biologic characteristics of paragangliomas of the nasal cavity and paranasal sinuses

Paragangliomas of the nasal cavity and paranasal sinuses are extremely rare. This study was conducted to investigate the biologic characteristics of these lesions on different molecular levels and to estimate their biologic behavior. Operative specimens of three patients who underwent surgery for a paraganglioma of the nasal cavity (one case) or paranasal sinuses (two cases) were investigated by routine histology, quantitative DNA analysis, and immunohistochemical assessment of proliferation markers (i.e., Proliferating Cell Nuclear Antigen, PCNA; Ki67-MIB-1), the expression of cell-surface antigens, which reflect the tumor-stroma interaction (i.e., CD 44 v0.4/5 and 6, CD 54, CD 106), oncogene products (nm-23; p53), and bcl-2 as a marker of apoptosis. Histologically, two tumors were paragangliomas of the adenomatous subtype, one lesion was classified as angiomatous. According to DNA analysis, aneuploid cells were detected in all tumors. Two of three paragangliomas were classified as a DNA type III pattern, implying a high percentage of aneuploid cells and an aggressive behavior. Immunohistochemically, paragangliomas of the nasal cavity showed increased scores for both proliferation markers tested, indicating a rapid growth pattern. According to the expression of cell-surface markers and oncogene products, these tumors displayed an aggressive behavior and an infiltrating growth pattern. The highest value for the parameters of quantitative DNA analysis and highest proliferation scores were found in a tumor of a patient who developed multiple tumor recurrences after radical excision of the lesion with clear margins, and finally died of disease. In conclusion, paragangliomas of the nasal cavity and paranasal sinuses examined in this study should be regarded as suspicious concerning their biologic and clinical behavior. Radical excision, and in cases with highly aggressive biology, postoperative radiation therapy are recommended. Tumor biologic examinations can help to recognize high-risk patients for developing recurrences and possibly lesions with a malignant behavior and to enhance our understanding of the biology of these extremely rare tumors of the nasal cavity and paranasal sinuses.

Nasal glomus tumors: report of two cases with emphasis on immunohistochemical features and differential diagnosis

We describe 2 cases of nasal glomus tumor that presented as nasal polyps. Grossly, each of the polypectomy specimens consisted of small fragments of polypoid soft tissue with glistening mucosa. Histopathological examination of each of the specimens showed sheets and nests of monomorphic round cells intimately associated with capillary-sized blood vessels. The tumor cells were strongly cytoplasmic positive for vimentin, smooth-muscle specific actin, muscle-specific actin, and CD34. Collagen IV showed pericellular positivity. Nasal glomus tumors are extremely rare and represent less than 0.5% of nasal nonepithelial tumors. Nasal polyps are common surgical pathological specimens, with the majority of nasal polyps being inflammatory polyps or a respiratory epithelial proliferation. Histologically, many nasal polyps show vascular proliferation with an inflammatory cell infiltrate, which may be confused with the rare glomus tumor. In addition, other nasal vascular tumors, in particular nasal hemangiopericytoma and neural tumors, may histologically mimic nasal glomus tumors.

Malignant paraganglioma of frontoethmoidal region

Nonchromaffin paragangliomas are unusual tumours arising from widely distributed paraganglionic tissues probably of neural crest origin. In the head and neck region they are usually seen as carotid body or jugulotympanic tumours. Other rarely reported sites in the head and neck region are the orbit, nose and larynx. This report deals with a case of sinonasal paraganglioma which was initially treated with surgery and radiotherapy. Twenty two years later the tumour recurred and showed a rapid growth due to malignant transformation which we believe is late effect of radiotherapy. The clinical features, histopathology and role of radiotherapy in sinonasal paragangliomas together with a review of the medical literature have been discussed.

Primary nasopharyngeal paraganglioma: a case report

We report a 49-year-old man with a paraganglioma involving the nasopharynx, which according to the literature is the fourth case in Japan and the twentieth in the world. The initial histopathologic findings of the biopsy specimen from the nasopharyngeal tumor suspected a carcinoid tumor. However, the final histopathologic diagnosis from the surgically resected specimen was paraganglioma, determined by electron microscopy and using several stains, such as Grimelius and Neuron-specific enolase (NSE) stains. We wish to add this case of "primary" nasopharyngeal paraganglioma to the literature, and to report the pathologic findings and clinical course of this unusual case.

Nasal and nasopharyngeal paraganglioma

Paragangliomas of the nasal cavity and nasopharynx should be classified according to the presumed origin from the nasal, jugulotympanic, vagal, or ciliary paraganglion because of the substantial differences in clinical behavior and operative management. This paper presents the ninth published case of a primary nasal paraganglioma and reviews the previously reported cases. Primary nasal paragangliomas are generally localized, although the potential for local invasion is well documented. Malignancy or functional activity has not been described. Complete excision is curative. Jugulotympanic, vagal, and ciliary paragangliomas with extension into the nasopharynx or nasal cavity are typically more advanced at the time of diagnosis and require complete evaluation by computed tomography and arteriography to determine the tumor extent. The operative approach is dependant on the extent of tumor invasion. Irradiation and tumor embolization have been useful for unresectable or partially excised tumors.

Paraganglioma of the sphenoid sinus appearing as labile hypertension

Paragangliomas, also known as glomus tumors, are unusual, generally benign tumors most commonly found in association with major vessels and cranial nerves. Only a small number of these tumors have been described arising in the paranasal sinuses, and none of these has been physiologically active. The following case report describes a metabolically active paraganglioma arising in the sphenoid sinus.

Non-chromaffin paraganglioma of the nasopharynx

A case of non-chromaffin paraganglioma of the nasopharynx is presented. Previously reported cases are discussed and classified, and theories of origin are reviewed in the light of new evidence suggesting a common origin for this rare tumour and juvenile angiofibroma of the nasopharynx.