J Rhinol.  2019 Nov;26(2):132-136. 10.18787/jr.2019.26.2.132.

Vascular Leiomyoma of the Nasal Floor: The Risk of Misdiagnosis

• Lee KI
• An HG
• Hong SR
• Kim JY
• In SM

• KMID: 2465547
• DOI: http://doi.org/10.18787/jr.2019.26.2.132

Abstract

Vascular leiomyoma (VL) is a rare tumor, particularly in the sinonasal region. The etiology of VL is unclear and there are a number of theories regarding how VL develops. To date, approximately 20 cases of VL have been reported in the sinonasal area. This is the first reported case of VL in the right nasal floor. We present the case of an adult patient with mild nasal obstruction and discomfort. Preoperative examination failed to accurately diagnose the patient with VL. Transnasal endoscopic resection was performed. There were no complications or recurrence postoperatively.

Keyword

Vascular leiomyoma; Nasal floor; Sinonasal tumor

MeSH Terms

Adult
Angiomyoma*
Diagnostic Errors*
Humans
Nasal Obstruction
Recurrence

Figure

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  Fig. 1 Endoscopic finding of a soft tissue mass in the right nasal floor. The mass has a round, reddish, and well-vascularized appearance.

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  Fig. 2 Preoperative CT scan revealed a slightly heterogenously enhanced mass with bony remodeling in the maxilla. Black asterisk indicates soft tissue density lesion of the right nasal floor. A: enhanced axial. B: non-enhanced axial. C: enhanced coronal. D: enhanced sagittal cut.

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  Fig. 3 Preoperative MRI showing the soft tissue tumor in the right nasal floor. A: T1 imaging showing an iso-signal intensity, B: T2 imaging showing mixed low and high signal intensities. C: T1 Gd-enhanced imaging showing a slightly heterogenous enhancement.

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  Fig. 4 The excised mass consists of a round, pinkish, and smooth soft tissue. Operative findings showed a well-capsulated soft tissue tumor in the right nasal floor without adhesion or bleeding. A: gross specimen. B: 30-degree endoscope view of the tumor removal. C: 0-degree endoscope view after tumor removal.

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  Fig. 5 Pathologic findings. Microscopically, the mass was composed of spindle cells with irregularly dilated, staghorn-shaped vessels. Masson's trichrome staining revealed fuchsinophilia of the spindle cells. Immunohistochemistry revealed a diffuse positive reaction for desmin and α-smooth muscle actin. A: Hematoxylin and eosin stain. B: Masson's trichrome stain. C: Immunohistochemistry for desmin. D: Immunohistochemistry for α-smooth muscle actin.

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  Fig. 6 Postoperative CT and endoscopic finding revealed no enhanced or residual mass in the right nasal floor. A: enhanced coronal. B: 0-degree endoscope.

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