Indian Journal of Pathology and Microbiology

CASE REPORT
Year
: 2009  |  Volume : 52  |  Issue : 3  |  Page : 386--388

Angioleiomyoma of the nasal cavity


Rajiv C Michael1, Sanjeev Shah2,  
1 Department of ENT, Christian Medical College and Hospital, Vellore - 632 004, Tamilnadu, India
2 Department of Pathology, Christian Medical College and Hospital, Vellore - 632 004, Tamilnadu, India

Correspondence Address:
Rajiv C Michael
Department of ENT, Christian Medical College and Hospital, Vellore - 632 004, Tamilnadu
India

Abstract

Angioleiomyoma is a rare benign tumor in the nasal cavity. There are very few reports in literature. A 34 year old male presented with left sided nasal obstruction and epistaxis. Clinical evaluation revealed a lesion replacing the anterior two-third of the Left inferior turbinate. An endoscopic excision under hypotensive anesthesia was performed. Histopathology confirmed a diagnosis of Angioleiomyoma. The cause and site of origin of angioleiomyomas when they arise from the inferior turbinate remains unclear. We review the literature available on nasal angioleiomyoma. When limited to the nasal cavity endoscopic excision is the treatment of choice.



How to cite this article:
Michael RC, Shah S. Angioleiomyoma of the nasal cavity.Indian J Pathol Microbiol 2009;52:386-388


How to cite this URL:
Michael RC, Shah S. Angioleiomyoma of the nasal cavity. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 Jan 22 ];52:386-388
Available from: http://www.ijpmonline.org/text.asp?2009/52/3/386/55002


Full Text

 Introduction



Angioleiomyomas are benign tumors of smooth muscle and extremely rare in the nasal cavity and paranasal sinuses.Common sites are the uterus and the gastrointestinal tract.[1] Angioleiomyomas makeup less than 1% of all benign tumors of the nose and paranasal sinuses. [1] They are reported as being more common in women. [2]

We present a vascular leiomyoma arising from the left inferior turbinate in a 34 year old man.

 Case Report



A 34 year old male presented to the ENT clinic with a 10 year history of Left sided nasal obstruction and recurrent epistaxis.There was no history of bleeding tendencies or previous blood transfusion. On examination the anterior two thirds of the left inferior turbinate was grossly edematous and swollen. A septal spur to the left was also present. On diagnostic rigid nasal endoscopy the findings on anterior rhinoscopy were confirmed. No other mass lesion or abnormality in the nose or nasopharynx was seen. Both middle meatus and sphenoethmoidal recess were normal.There was no active bleeding.

Computerized tomography (CT) scan showed an enhancing mass limited to the left inferior meatus and floor of the left nasal cavity [Figure 1]. There was no bony erosion and the paranasal sinuses and both the osteomeatal complex were normal. Due to the limited extent of the lesion on the CT scan and diagnostic nasal endoscopy an endoscopic approach for excision was planned under controlled hypotensive anesthesia.

Peroperatively a mass was found replacing the anterior two-third of the left inferior turbinate. The posterior end of the inferior turbinate and choana were free.The middle meatus and osteomeatal complex were normal bilaterally. The mass was excised completely with endoscopic bipolar cautery assisted dissection. The postoperative period was uneventful.

 Histopathology



Microscopic examination showed polypoid fragments of nasal mucosa covering a tumor composed of many thick walled vascular channels with inner coat of circumferentially arranged spindle cells. The outer layer blended with less well ordered spindle cells of tumor. The tumor cells had plump to elongated nuclei and eosinophilic fibrillary cytoplasm [Figure 2]. The tumor cells were immunopositive for smooth muscle actin [Figure 3] and Desmin [Figure 4].

 Discussion



Angioleiomyomas are rare tumors in the nasal cavity. This is probably due to the paucity of smooth muscle in this region.[3] Three theories have been put forward for the origin of angioleiomyomas: From aberrant undifferentiated mesenchyme, from smooth muscle in the wall of blood vessels, or from both. [4] When they arise in the nasal cavity they are reported as arising most frequently from the inferior turbinate. [5] Other reported sites include the nasal vestibule, within nasal polyps and from the nasal septum. [7],[6]

The cause of origin of nasal angioleiomyoma is uncertain. [7] Turbinates are known to contain vascular contractile tissue with smooth muscle fibres. Daisley (1987) [8] proposed that this smooth muscle is the origin of this tumor

Cases from the nasal vestibule can have other possible sources because skin contains smooth muscle not only in blood vessels but also erector pilae muscles and sweat glands. [9] Nasal or facial surgery with trauma as a cause has only been described in adequate detail in two cases. [1],[10] Hormone dependency has been suggested in a female patient. [2] Our patient was a 34 year old male who had no history of prior nasal trauma or previous nasal or paranasal sinus surgery.

Differential diagnosis of an angioleiomyoma should include myopericytoma, hemangioma, fibromyoma and leiomyosarcoma.[2] Myopericytoma are composed of thin walled vascular channels with whorled rounded to ovoid myopericytes which are positive for SMA and negative or only focally positive for Desmin. This case was diagnosed as a angioleiomyoma since the immunocyto chemistry revealed a strongly positive response for smooth muscle actin and desmin with the histological fascicular pattern of spindle shaped cells suggestive of leiomyoma.This has been documented in previous case reports. [4],[11]

In hemangiomas the intervascular stroma does not have smooth muscle bundles as in an angioleiomyoma. According to the WHO classification of head and neck tumors angioleiomyomas are vascular leiomyomas and leimyoblastoma is considered as a synonym. A Leiomyomsarcoma is a malignant smooth muscle tumor with nuclear atypia and mitosis. An occasional mitotic Figure can occur in angioleiomyoma. Angiofibromas are tumors with proliferated thin walled staghorn vascular channels in a stroma containing round to stellate to spindle shaped fibroblasts.

Surgical excision is the recommended treatment of choice as documented in previous studies. [1],[4],[11] A preoperative CT scan is essential for evaluation of extension to the paranasal sinuses, to look for bony erosion and to plan the most appropriate surgical approach. For our case we found an endoscopic approach with controlled hypotension provided adequate exposure and control over haemostasis.

In conclusion, Angioleiomyomas though rare tumors in the nasal cavity should be considered in the differential diagnosis of all vascular neoplasms of the nasal cavity. They need to be differentiated from myopericytomas. We suggest that for small sized lesions limited to the nasal cavity an endoscopic approach affords excellent local control. Where limited to the nasal cavity preoperative angiography and embolization are not required.

References

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