Endoscopic resection of invasive glomangiopericytoma following preoperative embolisation: A case report and literature review
DOI:
https://doi.org/10.34631/sporl.568Keywords:
Glomangiopericitoma, embolização, cirurgiaAbstract
Objectives: The sinonasal hemangiopericytomas (SNHPC) are rare tumors, originating from perivascular modified myoepithelial cells, and are often referred as glomangioperycitomas (GPC). These lesions have a rather benign local behavior, with rare metastasis rate but high recurrence rate. Histologically are classified as low-grade malignant lesions. The treatment is the complete excision of the lesion with intraoperative disease free surgical margins.
Methods: Case report: 60 years old woman with 2 years symptoms of nasal obstruction and unilateral recurrent epistaxis. Anterior rhinoscopy identified a unilateral hypervascular mass that occupied the entire left nasal cavity. Imaging studies documented the presence of extensive lesion of the left nasal cavity with complete infiltration of the anterior ethmoid, limited indentation of the medial wall of the orbit, bone demineralization of the left cribriform plate and involvement of the anterior cranial fossa. The pathological diagnosis of locally advanced GPC was done preoperatively by biopsy of the lesion resulting in a self-limited epistaxis confirming the vascular nature of the lesion. We discuss the diagnostic workup, imaging and surgical approach of this tumor and a review of the literature on endoscopic treatment of these lesions.
Results: Preoperative embolization removed 90% of the vascularization of the lesion in dependence of the infraorbital artery. We performed a complete excision of the lesion by direct endoscopic transethmoidal hemi-craniectomy. No complications associated with the technique and no postoperative locoregional recurrence was reported on follow-up.
Conclusion: Endoscopic treatment of GPC is safe and effective with results superior to those described by the external approach. Preoperative embolization of these lesions is advantageous in reducing blood feeding and blood loss intraoperatively allowing a safe and well-controlled endoscopic resection.
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