AB090. 93. A serendipitous fall

Background: This is a case report exploring a rare cause of nasal obstruction: sinonasal hemangiopericytoma.

Methods: A 54-year-old lady was referred to the ear nose & throat (ENT) department after a computed tomography (CT) brain following a fall revealed a mass in her left nasal cavity. On history, the patient had been suffering from left nasal obstruction for some time, as well as recurrent left eye infections. Further evaluation with nasendoscopy revealed a polypoidal lesion arising from the middle turbinate, with a vascular stalk, causing marked widening of the left nasal cavity. Excisional biopsy was performed. Histology revealed a spindle cell tumour with an immunohistochemistry profile favouring a diagnosis of hemangiopericytoma.

Results: A hemangiopericytoma is a rare tumour of uncertain malignant potential. It accounts for just 1% of all vascular neoplasms, of which 15% occur in the head and neck. Originally described in 1942, it arises from Zimmermann pericytes; cells with smooth muscle characteristics that line capillary walls. These tumours, when in the nasal cavity, commonly present with nasal obstruction, epistaxis, or, as in our case, incidentally on imaging. Treatment of choice is surgical excision. Recurrence rates vary in the literature, from between 7–20% with an average timeframe of 7 years to recurrence. Indeed, our patient is 2.5 years post excision, with no recurrence of symptoms to date.

Conclusions: Although it may not have felt it at the time, it was a happy accident that brought this patient to the ENT department. The incidental finding on CT allowed timely management of this treatable disease, before the development of incapacitating symptoms.

Keywords: Sinonasal mass; nasal obstruction; hemangiopericytoma