Hemangiopericytoma of the nasal cavity. (Imaging Clinic).

A hemangiopericytoma is the result of a rare soft-tissue neoplastic process that can occur in any part of the body. A nasal hemangiopericytoma can appear clinically as an obstructive soft-tissue mass associated with epistaxis, as occurred in the case of a 35-year-old black woman who came to our institution. Computed tomography (CT) (figure 1) and magnetic resonance imaging (MRI) (figure 2) revealed that a vascularized mass had occupied the left side of her nasal cavity. Complete excision of the mass was performed, and at the 6-month follow-up, there was no evidence of recurrence.

Hemangiopericytomas have been recognized as distinct neoplastic entities since they were originally described in 1942. (1) These mesenchymal tumors are thought to be derived from pericytes. (2) Most hemangiopericytomas occurin the lower extremities and retroperitoneum, but an estimated 15 to 20% occur in the head and neck, including the sinonasal area, larynx, and parapharyngeal soft tissues. (3) The ethmoid sinuses appear to be the most common site of origin in the head and neck, followed by the nasal cavity. These tumors occur more often during middle age, and there is a slight female preponderance. The most common symptoms are nasal obstruction and epistaxis. In its clinical course, a hemangiopericytoma can follow either a malignant or benign path, and local recurrences and metastases have been observed years after the initial diagnosis. Therefore, postoperative radiotherapy is advocated by some. (4)

References

(1.) Stout AP, Murray MR. Hemangiopericytoma: A vascular tumor featuring Zimmermann's pericytes. Ann Surg 1942;116:26-33.

(2.) Millman B, Brett D, Vrabec DP. Sinonasal hemangiopericytoma. Ear Nose Throat J 1994;73:680-2, 687.

(3.) Weber W, Henkes H, Metz KA, et al. Haemangiopericytoma of the nasal cavity. Neuroradiology 2001;43:183-6.

(4.) Billings KR, Fu YS, Calcaterra TC, Sercarz JA. Hemangiopericytoma of the head and neck. Am J Otolaryngol 2000;21:238-43.

From the Department of Radiology (Dr. Palacios) and the Department of Otorhinolaryngology (Dr. Miller), Louisiana State University Health Sciences Center, New Orleans.