Objectives. Hemangiopericytoma is a rare tumor entity deriving from pericytes. Less than 5% of hemangiopericytoma occur in the nasal cavity and are characterised by a rather benign nature with low tendency of metastasis. However, as the recurrence rate in the literature ranges from 9.5% to 50%—depending on the length of followup—a radical surgical resection is considered as the gold-standard treatment. Only a few years ago, a wide external approach, usually via lateral rhinotomy or Caldwell-Luc, was performed. Endoscopic techniques were regarded as appropriate for small low-vascularised tumors only. Methods. We present the case of a 64-year-old patient with an extended sinonasal hemangiopericytoma, who was successfully treated by an endoscopic controlled endonasal tumor resection after embolisation with Onyx. Further, to support the new treatment option, we review the literature concerning all features of sinonasal hemangiopericytomas and their therapeutical management. Results/Conclusion. Onyx, which has not been described in the context of hemangiopericytoma yet, is a very effective embolic agent for a preoperative embolisation of sinonasal hemangiopericytoma allowing a safe endoscopic surgery. 1. Introduction Sinonasal hemangiopericytomas are a rare upper aerodigestive tract tumor deriving from perivascular modified smooth muscle cells. This vascular neoplasm firstly described in 1943 by Stout and Murray [1] may arise in any part of the body [2]; only 15%–30% are located in the head and neck region [3]. Of these, only 5% are found in the nasal cavity and paranasal sinus [4]. Hemangiopericytoma located in the nasal region is frequently characterized by a more benign nature with low tendency of metastasis [5]; however, sinonasal hemangiopericytoma exhibits a recurrence rate of approximately 25% [3]. In the last two decades, less than 250 cases have been published so that sinonasal hemangiopericytoma represents a rather rare tumor entity. A total of 57 patients out of the 250 analysed cases underwent an endoscopic tumor resection, of which 23 patients received a preoperative embolisation of the high vascularised hemangiopericytoma. Here, we review the relevant literature and report about a 64-year-old patient presenting with sinonasal hemangiopericytoma. We used a liquid embolic agent, consisting of an ethylene vinyl alcohol dissolved in the organic solvent dimethyl sulfoxide (DMSO) and containing tantalum powder for radiopacity (Onyx) and performed an endoscopically controlled resection. To our knowledge, this is the first report about preoperative
References
[1]
A. P. Stout and M. P. Murray , “Hemangiopericytoma. A vascular tumor featuring Zimmerman's pericytes,” Annals of Surgery, vol. 116, no. 1, pp. 26–33, 1943.
[2]
M. L. Navarrete, J. Maeso, and M. Pellicer, “Hemangiopericytoma of the nasal septum,” European Archives of Oto-Rhino-Laryngology, vol. 247, no. 6, pp. 384–386, 1990.
[3]
J. G. Batsakis, J. B. Jacobs, and A. C. Templeton, “Hemangioperictyoma of the nasal cavity: electron-optic study and clinical correlations,” The Journal of Laryngology & Otology, vol. 97, pp. 361–368, 1983.
[4]
J. G. Batsakis and D. H. Rice, “The pathology of head and neck tumors: vasoformative tumors, part 9B,” Head and Neck Surgery, vol. 3, no. 4, pp. 326–339, 1981.
[5]
J. Compagno and V. J. Hyams, “Haemangiopericytoma-like tumour intranasal tumours: a clinicopathologic study of 23 cases,” American Journal of Clinical Pathology, vol. 66, pp. 672–683, 1976.
[6]
L. Barnes, J. W. Eveson, P. Reichart, and D. Sidransky, Eds., World Health Organization Classification of Tumours: Pathology and Genetics of Head and Neck Tumours, IARC Press, Lyon, France, 2005.
[7]
L. L. Y. Tse and J. K. C. Chan, “Sinonasal haemangiopericytoma-like tumour: a sinonasal glomus tumour or a haemangiopericytoma?” Histopathology, vol. 40, no. 6, pp. 510–517, 2002.
[8]
T. Kn？sel, B. Schulz, K. Katenkamp, D. Katenkamp, and I. Petersen, “Solitary fibrous tumor and haemangiopericytoma: what is new?” Pathologe, vol. 31, no. 2, pp. 123–128, 2010.
[9]
F. M. Enzinger and B. H. Smith, “Hemangiopericytoma: an analysis of 106 cases,” Human Pathology, vol. 7, no. 1, pp. 61–82, 1976.
[10]
T. Wilson, H. B. Hellquist, S. Ray, and J. Pickles, “Intranasal myopericytoma. A tumour with perivascular myoid differentiation: the changing nomenclature for haemangiopericytoma,” Journal of Laryngology and Otology, vol. 121, no. 8, pp. 786–789, 2007.
[11]
B. Millman, D. Brett, and D. P. Vrabec, “Sinonasal hemangiopericytoma,” Ear, Nose and Throat Journal, vol. 73, no. 9, pp. 680–687, 1994.
[12]
J. H. Eichhorn, G. R. Dickersin, A. T. Bhan, and M. L. Goodman, “Sinonasal hemangiopericytoma. A reassessment with electron microscopy, immunohistochemistry, and long-term follow-up,” American Journal of Surgical Pathology, vol. 14, no. 9, pp. 856–866, 1990.
[13]
G. Gillman and J. B. Pavlovich, “Sinonasal hemangiopericytoma,” Otolaryngology, vol. 131, no. 6, pp. 1012–1013, 2004.
[14]
A. Gorenstein, G. W. Facer, and L. H. Weiland, “Hemangiopericytoma of the nasal cavity,” Otolaryngology, vol. 86, no. 3, pp. 405–415, 1978.
[15]
P. Sabini, G. D. Josephson, R. T. Yung, and J. N. Dolitsky, “Hemangiopericytoma presenting as a congenital midline nasal mass,” Archives of Otolaryngology, vol. 124, no. 2, pp. 202–204, 1998.
[16]
E. G. Thomaser, K. Tschopp, I. Oehri, G. Carthomas, and S. Hailemariam, “Sinonasal hemangiopericytoma,” HNO, vol. 52, no. 12, pp. 1091–1096, 2004.
[17]
P. J. Catalano, M. Brandwein, D. K. Shah, M. L. Urken, W. Lawson, and H. F. Biller, “Sinonasal hemangiopericytomas: a clinicopathologic and immunohistochemical study of seven cases,” Head and Neck, vol. 18, no. 1, pp. 42–53, 1996.
[18]
Z. Nemes, “Differentiation markers in hemangiopericytoma,” Cancer, vol. 69, no. 1, pp. 133–140, 1992.
[19]
T. Hansen, K. Katenkamp, and D. Katenkamp, “D2-40 staining in sinonasal-type hemangiopericytoma—further evidence of distinction from conventional hemangiopericytoma and solitary fibrous tumor,” Virchows Archiv, vol. 448, no. 4, pp. 459–462, 2006.
[20]
N. Bhattacharyya, N. L. Shapiro, and R. Metson, “Endoscopic resection of a recurrent sinonasal hemangiopericytoma,” American Journal of Otolaryngology, vol. 18, no. 5, pp. 341–344, 1997.
[21]
M. A. A. Fuster, C. R. Sala, V. C. Vizcaíno, C. D.-A. Hermida, and J. V. Molina, “Sinonasal hemangiopericytoma,” Acta Otorrinolaringologica Espanola, vol. 52, no. 8, pp. 699–702, 2001.
[22]
E. Serrano, A. Coste, J. Percodani, S. Hervé, and L. Brugel, “Endoscopic sinus surgery for sinonasal haemangiopericytomas,” Journal of Laryngology and Otology, vol. 116, no. 11, pp. 951–954, 2002.
[23]
W. Weber, H. Henkes, K. A. Metz, E. Berg-Dammer, and D. Kühne, “Haemangiopericytoma of the nasal cavity,” Neuroradiology, vol. 43, no. 2, pp. 183–186, 2001.
[24]
P. Castelnuovo, F. Pagella, G. Delù, M. Benazzo, and M. Cerniglia, “Endoscopic resection of nasal haemangiopericytoma,” European Archives of Oto-Rhino-Laryngology, vol. 260, no. 5, pp. 244–247, 2003.
[25]
A. P. Stout, “Hemangiopericytoma; a study of 25 cases,” Cancer, vol. 2, no. 6, pp. 1027–1054, 1949.
[26]
R. E. Mosesson and P. M. Som, “The radiographic evaluation of sinonasal tumors: an overview,” Otolaryngologic Clinics of North America, vol. 28, no. 6, pp. 1097–1115, 1995.
[27]
E. Palacios, S. Restrepo, L. Mastrogiovanni, G. D. Lorusso, and R. Rojas, “Sinonasal hemangiopericytomas: clinicopathologic and imaging findings,” Ear, Nose and Throat Journal, vol. 84, no. 2, pp. 99–102, 2005.
[28]
C. Davies, B. Schick, H. Kronsbein, and J. Hendus, “Hemangiopericytoma and hepatic metastasis,” HNO, vol. 47, no. 3, pp. 183–187, 1999.
[29]
S. A. Reiner, G. J. Siegel, K. F. Clark, and K. W. Min, “Hemangiopericytoma of the nasal cavity,” Rhinology, vol. 28, no. 2, pp. 129–136, 1990.
[30]
H. P. Boey, S. Mitra, and E. Yanagisawa, “Intranasal hemangiopericytoma,” Ear, Nose and Throat Journal, vol. 77, no. 12, pp. 944–945, 1998.
[31]
H. M. Abdel-Fattah, G. L. Adams, and M. R. Wick, “Hemangiopericytoma of the maxillary sinus and skull base,” Head and Neck, vol. 12, no. 1, pp. 77–83, 1990.
[32]
W. Taki, Y. Yonekawa, H. Iwata, A. Uno, K. Yamashita, and H. Amemiya, “A new liquid material for embolization of arteriovenous malformations,” American Journal of Neuroradiology, vol. 11, no. 1, pp. 163–168, 1990.
[33]
A. J. Molyneux, S. Cekirge, I. Saatci, and G. Gál, “Cerebral Aneurysm Multicenter European Onyx (CAMEO) Trial: results of a prospective observational study in 20 European centers,” American Journal of Neuroradiology, vol. 25, no. 1, pp. 39–51, 2004.
[34]
Y. P. Gobin, Y. Murayama, K. Milanese et al., “Head and neck hypervascular lesions: embolization with ethylene vinyl alcohol copolymer—laboratory evaluation in swine and clinical evaluation in humans,” Radiology, vol. 221, no. 2, pp. 309–317, 2001.
[35]
P. Gore, N. Theodore, L. Brasiliense et al., “The utility of onyx for preoperative embolization of cranial and spinal tumors,” Neurosurgery, vol. 62, no. 6, pp. 1204–1211, 2008.
[36]
Y. Cohen, C. Lichtig, and E. Robinson, “Combination chemotherapy in the treatment of metastatic hemangiopericytoma,” Oncology, vol. 26, no. 2, pp. 180–187, 1972.
[37]
P. P. Wong and A. Yagda, “Chemotherapy of malignant hemangiopericytoma,” Cancer, vol. 41, no. 4, pp. 1256–1260, 1978.
[38]
K. D. Backwinkel and J. A. Diddams, “Hemangioperizytoma,” Cancer, vol. 25, pp. 896–901, 1970.
[39]
A. K. El-Naggar, J. G. Batsakis, G. M. Garcia, M. L. Luna, and H. Goepfert, “Sinonasal hemangiopericytomas: a clinicopathologic and DNA content study,” Archives of Otolaryngology, vol. 118, no. 2, pp. 134–137, 1992.
