Sinonasal glomangiopericytoma presenting as refractory epistaxis: imaging, embolisation and pathological correlation

Area of Science:

• Otorhinolaryngology
• Neurosurgery
• Vascular Oncology

Background:

• Sinonasal glomangiopericytoma (GPC) is a rare perivascular tumor, comprising less than 0.5% of sinonasal neoplasms.
• Refractory unilateral epistaxis can be a challenging clinical presentation, often requiring aggressive management.

Purpose of the Study:

• To report a case of sinonasal glomangiopericytoma presenting with refractory epistaxis.
• To illustrate the diagnostic and management challenges of this rare sinonasal tumor.
• To highlight the role of embolisation and endoscopic resection in managing such cases.

Main Methods:

• A case of a male patient in his 60s on anticoagulation presenting with epistaxis.
• Diagnostic workup including nasoendoscopy and MRI.
• Interventions: internal maxillary artery embolisation and endoscopic resection.
• Histopathological confirmation of GPC.

Main Results:

• Successful haemostasis achieved with embolisation and nasal packing.
• Nasoendoscopy revealed a vascular lesion near the olfactory cleft.
• MRI showed a contrast-enhancing mass abutting the cribriform plate.
• Endoscopic biopsy confirmed GPC, followed by resection.
• Postoperative recovery was uncomplicated with epistaxis resolution.
• Surgical margin was transected, indicating incomplete excision requiring surveillance.

Conclusions:

• Sinonasal glomangiopericytoma is a rare cause of refractory epistaxis.
• Diagnostic vigilance and multidisciplinary management are crucial.
• Embolisation may play a role in managing high-risk patients with epistaxis from sinonasal tumors.
• Close surveillance is necessary following potentially incomplete tumor resection.