Lobular Capillary Hemangioma of the Ethmoid Sinus: A Report of Two Cases

Abstract

Soft-tissue tumors are rare in the paranasal region. Lobular capillary hemangioma (LCH) is a distinctive vascular lesion most commonly seen on the skin and oral mucosa in the fourth and fifth decades of life. Forasmuch as the nasal cavity and paranasal sinuses are rare locations for LCH, it is not well known by many ENT surgeons. Here we present two cases of LCH of the ethmoid sinus. These cases are being reported owing to their scarcity as per the literature published global.

Management of Capillary Hemangioma of the Sphenoid Sinus

“…Another particular aspect of a lesion limited to the sinus cavity is the possibility of developing bony erosion through mass effect and locoregional extension without invasion into the surrounding structures. In advanced cases with orbital implication, ocular symptoms (proptosis, reduced eye mobility, impaired vision, ocular globe displacement) will accompany the nasal ones [ 19 ]. When intracranial involvement is also present, the neurologic symptoms are associated with the nasal manifestations [ 1 ].…”

“…The relationship between the tumor and the base of the skull and orbit should be thoroughly checked. Binesh et al reported two cases of ethmoid capillary hemangioma associated with bone erosion of the lamina papyracea in both adults and children; one case presented extensive bone erosion into the nasal septum and cribriform plate with extension into the anterior cranial fossa [ 19 ]. Pas M. et al presented a case of left ethmoid and sphenoid sinus capillary hemangioma with involvement of the left cavernous sinus, extensive bone erosion, and intrasellar and parasellar extension [ 1 ].…”

“…Sometimes the histological diagnosis of capillary hemangioma can be difficult due to the endothelial proliferation pattern that resembles malignant lesions and ulceration that corresponds to granulation tissue [ 14 ]. Differential diagnosis can be made with nasal angiofibroma (when the patient is an adolescent male juvenile, angiofibroma can be taken into account), angiomatous polyp of the nose and sinuses, polypoid granulation tissue, inverted papilloma, lymphangioma, hemangiolymphangioma, glomangiopericytoma, or angiosarcoma [ 9 , 18 , 19 , 21 ]. Angiofibromas contain large-diameter blood vessels and stellate fibroblasts, which differ from the small-diameter vessels encountered in capillary hemangiomas [ 19 ].…”

“…Differential diagnosis can be made with nasal angiofibroma (when the patient is an adolescent male juvenile, angiofibroma can be taken into account), angiomatous polyp of the nose and sinuses, polypoid granulation tissue, inverted papilloma, lymphangioma, hemangiolymphangioma, glomangiopericytoma, or angiosarcoma [ 9 , 18 , 19 , 21 ]. Angiofibromas contain large-diameter blood vessels and stellate fibroblasts, which differ from the small-diameter vessels encountered in capillary hemangiomas [ 19 ]. Hemangiolymphangiomas are rare, lymph-containing vascular tumors characterized by multiple lymph vessels surrounded by loose fibrovascular stroma [ 2 , 21 ].…”

“…Hemangiolymphangiomas are rare, lymph-containing vascular tumors characterized by multiple lymph vessels surrounded by loose fibrovascular stroma [ 2 , 21 ]. Glomangiopericytomas present more cells and less endothelial lining than capillary hemangiomas [ 19 ]. Angiosarcomas present malignant endothelial cells with extravascular extension and an infiltrative pattern, whilst capillary hemangiomas possess normal endothelial cells with no extravascular extension [ 11 ].…”