Leiomyoma of the nasal septum

Diagnosis, Treatment and Follow-Up of Sinonasal Leiomyomas: A Systematic Review

BACKGROUND

Leiomyomas are benign smooth muscle tumors that are rarely diagnosed in the nasal cavity and paranasal sinuses.

OBJECTIVE

This systematic review summarizes the histopathologic and clinical tumor characteristics, surgical management, and follow-up of sinonasal leiomyomas.

METHODS

A systematic review of the literature on sinonasal leiomyoma was performed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies that met the inclusion criteria were assessed for level of evidence. Patient demographics, clinical and pathological tumor characteristics, primary intervention, and results of follow-up were evaluated.

RESULTS

Forty studies including 84 patients with sinonasal leiomyoma were identified. The tumor was most often located in the nasal cavity (47/84, 56%) originating from the inferior turbinate (32/84, 38%). Patients mostly presented with symptoms originating from an intranasal mass, including recurrent epistaxis (41/84, 49%), nasal obstruction (43/84, 51.2%), and localized facial or head pain (25/84, 29.8%). Surgery was performed in all cases. An endoscopic approach was most frequently chosen. Recurrence occurred only twice (2.4%). Morbidity was noted in 2 cases (2.4%) following postoperative bleeding and 1 (1.2%) case following a CSF leak.

CONCLUSION

Sinonasal leiomyomas are neoplasms of the smooth muscle manifesting clinically with recurrent epistaxis and nasal obstruction. Management goal is total resection with clear margins to avoid local recurrence.

Nasal Septal Angioleiomyoma and Septal Sinus Surgery: A Review of 2 Cases

Angioleiomyomas are smooth muscle masses originating from blood vessel tunica media. This is a rare tumor, comprising less than 1% of benign sinonasal cavity tumors. Failure to recognize and surgically excise nasal angioleiomyomas can result in lesion recurrence. We present 2 new cases of nasal septum angioleiomyoma at a single institution. Additionally, both cases underwent septal and nasal surgery. Due to the nonspecific clinical and imaging findings, a high index of suspicion is needed to diagnose nasal septum angioleiomyoma, often requiring histopathological verification. Preferred treatment is complete surgical excision. From our experience, concurrent corrective septal and sinus surgery can be completed with tumors less than 1.0 cm in size.

Sinonasal Angioleiomyoma: A Rare Entity

The present case of angioleiomyoma of the nasal cavity in a 59-year-old male is unique, being the first case from North India and also because of its unique area of origin. The patient was referred to the Ear, Nose and Throat Outpatient Department with a diagnosis of an asymptomatic nasal mass. Biopsy done on the mass in another hospital reported angiofibroma. Excision was done after all relevant investigations. Histopathology revealed diagnosis of angioleiomyoma. Immunohistochemistry revealed desmin, SMA, and H-caldesmon positivity, consistent with the diagnosis of angioleiomyoma. Our case report thus highlights the im-portance of including this diagnosis in the differential diagnoses of nasal masses.

Lobular capillary hemangiomas: Case report and review of literature of vascular lesions of the nasal cavity

Vascular tumors of the nasal cavity can represent a variety of pathologies. In this case report, we discuss two patients presenting with a large vascular lesion occupying the nasal cavity. Significant bleeding was encountered during the initial attempts for endoscopic surgical resection. One lesion was successfully excised following preoperative embolization while a second following sphenopalatine artery vascular ligation. In both cases, final pathology showed lobular capillary hemangioma (LCH). We present a literature review and discussion of LCH and other vascular tumors that present in the nasal cavity. In addition, we discuss the utility of pre-resection vascular control of these tumors.

Leiomyoma of External Auditory Canal

This article reports a case of piloleiomyoma of external auditory canal, which is the 7th case of leiomyoma of the external auditory canal being reported and the 2nd case of leiomyoma arising from arrectores pilorum muscles, all the other five cases were angioleiomyomas, arising from blood vessels. A 52 years old male presented with a mass in the right external auditory canal and decreased hearing of 6 months duration. Tumor excision done by end aural approach. Histopathological examination report was leiomyoma. It is extremely rare for leiomyoma to occur in the external auditory canal because of the non-availability of smooth muscles in the external canal. So it should be considered as a very rare differential diagnosis for any tumor or polyp in the ear canal.

Expression of estrogen and progesterone receptors in angioleiomyoma of the nasal cavity of six patients

Angioleiomyoma of the nasal cavity is extremely rare. There are only a small number of studies in the literature that demonstrate that the estrogen receptor (ER) and progesterone receptor (PR) are expressed in angioleiomyoma, and the results from these studies are inconsistent. The present study identified 6 patients with nasal angioleiomyoma that were treated between 2004 and 2013. All patients underwent endoscopic surgery and were followed-up for 1–10 years. Resected tumors were investigated for the presence of ER and PR using immunoperoxidase staining. Of the 6 patients, 4 were men and 2 were woman. The mean age of the patients was 60.5 years. The tumors of the 6 patients were identified in the nasal septum, middle turbinate, inferior turbinate, lateral wall of the nasal cavity and nasal vestibule. The clinical manifestations reported by the patients consisted of a painless mass, recurrent epistaxis and nasal obstruction. There were no specific features observed in any of the patients using computed tomography or magnetic resonance imaging. All the patients underwent tumor dissection visualized with a nasal endoscope and recovered without recurrence or malignancy of the tumor post-surgery. Hematoxylin and eosin and immunoperoxidase staining confirmed the diagnosis of angioleiomyoma in all patients. In 5 patients the nuclei of the smooth muscle tumor cells markedly expressed ER and PR. To the best of our knowledge, the present study is the first to demonstrate that ER and PR are clearly expressed in nasal angioleiomyoma. The present study suggests that the sex hormones are possibly associated with the growth of angioleiomyoma.

Recurrent angioleiomyoma of the middle turbinate

We present a case of a middle-aged woman with a history of not only progressive nasal obstruction, facial pain, hyposmia and epistaxis, but also excision of the nasal mass diagnosed as a vascular leiomyoma. On examination, a smooth bulge was seen over the middle turbinate. Surgical excision along with histopathology and immunohistochemistry revealed a diagnosis of recurrent vascular leiomyoma of the middle turbinate.

A rare case of intranasal vascular leiomyoma

Vascular leiomyoma (VL) is a solitary and rare form of leiomyoma that usually occurs in the skin or subcutaneous tissue of the lower extremities. Intranasal VL is extremely rare, probably due to the lack of smooth muscle in the nasal cavity. In this study, we report a case of a 70-year-old woman with VL of the inferior nasal turbinate. An endoscopic examination revealed a pinkish globular mass at the inferior turbinate. A preoperative CT scan exhibited a highly enhanced mass originating from the inferior turbinate, and haemangioma was suspected. The patient underwent complete excision of the mass endoscopically, and the histopathological report indicated that the mass was a VL. The tumour was determined to be negative for progesterone and estrogen receptors by immunohistochemical staining. The postoperative period was uneventful. There was no local recurrence during the 12-month follow-up period.

Angioleiomyoma of the Sinonasal Tract: Analysis of 16 Cases and Review of the Literature

Angioleiomyoma (ALM; synonyms: angiomyoma, vascular leiomyoma) is an uncommon benign tumor of skin and subcutaneous tissue. Most arise in the extremities (90 %). Head and neck ALMs are uncommon (~10 % of all ALMs) and those arising beneath the sinonasal tract mucosa are very rare (<1 %) with 38 cases reported so far. We herein analyzed 16 cases identified from our routine and consultation files. Patients included seven females and nine males aged 25-82 years (mean 58; median 62). Symptoms were intermittent nasal obstruction, sinusitis, recurrent epistaxis, and a slow-growing mass. Fifteen lesions originated within different regions of the nasal cavity and one lesion was detected incidentally in an ethmoid sinus sample. Size range was 6-25 mm (mean 11). Histologically, all lesions were well circumscribed but non-encapsulated and most (12/16) were of the compact solid type superficially mimicking conventional leiomyoma but contained numerous compressed muscular veins. The remainder were of venous (2) and cavernous (2) type. Variable amounts of mature fat were observed in four cases (25 %). Atypia, necrosis, and mitotic activity were absent. Immunohistochemistry showed consistent expression of smooth muscle actin (12/12), h-caldesmon (9/9), muscle-specific actin (4/4), variable expression of desmin (11/14) and CD56 (4/6), and absence of HMB45 expression (0/11). The covering mucosa was ulcerated in 6 cases and showed squamous metaplasia in one case. There were no recurrences after local excision. Submucosal sinonasal ALMs are rare benign tumors similar to their reported cutaneous counterparts with frequent adipocytic differentiation. They should be distinguished from renal-type angiomyolipoma. Simple excision is curative.

Angioleiomyoma of the nasal cavity

Introduction Vascular leiomyoma of the nasal cavity is an extremely rare tumor that represents less than 1% of all vascular leiomyomas. It is more prevalent in women between the fourth and sixth decades, reaching primarily the inferior nasal turbinates. Objectives Reporting and assisting the systematization of more accurate diagnostic methods in clinical and complementary investigation of vascular leiomyoma in the nasal cavity. Resumed Report We present the case of a 49-year-old woman diagnosed with vascular leiomyoma in the nasal cavity, which manifested mainly with nasal obstruction. During investigation, computer tomography was not diagnostic, the cytologic study was not conclusive, and according to the biopsy, it was a squamous papilloma. Conclusion We suggest that the technical difficulty in obtaining an adequate amount of material for preoperative biopsy, associated with the topography of the lesion in the vestibular nasal region, may have contributed to changing the postoperative diagnosis. Thus, pathologic study of the surgical fragment is the more accurate method for diagnosis.

[Leiomyoma. A rare neoplasia of the parotid gland]

Leiomyomas are benign neoplasias consisting of smooth muscle tissue, with the most common localization being the uterus. Less often incidence is observed in other regions such as the blood vessels, esophagus and lower urinary tract. Leiomyomas occur only rarely in the head and neck area. We report about a female patient being treated because of progredient swelling and enlargement of the left parotid gland. The histological specimen revealed a regressive transformed tumor.