Focal vascular malformation in the nasal cavity.

Most vascular tumors of the nasal cavity, such as hemangiomas and vascular malformations, occur in the septum (65% of cases), the lateral wall (18%), or the vestibule (16%). (1) Most of these vascular lesions arise in the anterior septum and are of the capillary type. (1-3) We describe a case of vascular malformation.

A 78-year-old white man with a history of colon cancer, diabetes, hypertension, peripheral vascular disease, cerebrovascular accidents, and hyperlipidemia presented with a complaint of nasal obstruction and epistaxis. Eight months earlier, computed tomography (CT) had been obtained at another institution following a cerebrovascular accident. That study detected a 1-cm mass in the anterosuperior nasal cavity. Because the patient felt that the mass had since increased in size, we obtained a repeat CT; coronal and axial images were taken of the facial bones, including the paranasal sinuses. These CTs revealed the presence of a destructive soft-tissue mass that involved the anterior aspect of the nasal bridge (figure 1). These findings were suggestive of an infiltrating neoplasm.

[FIGURE 1 OMITTED]

During surgery, the mass was noted to originate in the left nasal bone. It crossed the dorsum and midline, involved the right nasal bone, and extended superiorly to the frontal process of the nasal bone.

Frozen-section analysis of the excised tumor did not detect any malignancy. Microscopic examination of the specimen identified it as a vascular lesion that was made up of endothelium-lined, blood-filled, thin-walled vascular spaces and mixed with thicker vessels with smooth muscle in their walls (figure 2). Perivascular fibrosis was also noted. Bony spicules were seen between the blood vessels. No marrow elements were present, and no mitoses or other features suggesting a malignant process were noted. We concluded that the lesion represented a benign vascular malformation involving bone rather than an infiltrative malignant neoplasm.

[FIGURE 2 OMITTED]

The patient was seen again 8 months following surgery. The rhinotomy incision was well healed, and there was no evidence of residual or recurrent disease.

The clinical and imaging differential diagnosis of a nasal mass should include hemangioma, malignant vascular tumor (angiosarcoma), pyogenic granuloma (lobular capillary hemangioma), nasal polyp, and hamartoma. (4)

References

(1.) Som PM, Brandwein MS. Tumors and tumor-like conditions. In: Som PM, Curtin HD, eds. Head and Neck Imaging. 4th ed, vol. 1. St. Louis: Mosby, 2003:261-373.

(2.) Kapella M, Panosetti E, Rombaux P, et al. Lobular capillary haemangioma of the nasal cavity: Observation of three specific cases. Acta Otorhinolaryngol Belg 2001;55:241-6.

(3.) Karagama YG, Howarth K, Steel PR, Spencer MG. Lobular capillary haemangioma of the nasal vestibule: A rare entity. Int J Pediatr Otorhinolaryngol 2002;66:71-5.

(4.) Yanagisawa E, Mirante JP, Christmas D. Endoscopic view of a nasal septal hemangioma causing obstruction. Ear Nose Throat J 2004;83:11-12.

From the Department of Pathology (Dr. Lorusso and Dr. Sarma) and the Department of Radiology (Dr. Palacios), Louisiana State University Health Sciences Center and VA Medical Center, New Orleans.