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Sino-nasal hemangiopericytoma: a case series and systematic literature review

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Abstract

Background

Hemangiopericytoma is a rare tumor of the sino-nasal tract. Its clinical behavior is controversial. Whereas some describe an indolent course, others consider it to be an aggressive lesion with a tendency toward rapid local recurrence. Here, we describe our experience in the management of sino-nasal hemangiopericytoma (SN-HPC), comparing our experience with the current literature, and evaluating signs and tools to improve diagnosis and treatment.

Methods

All cases of SN-HPC between 2010 and 2020 were extracted and reviewed from our institutional electronic medical records. SN-HPC cases from PubMed and EMBASE between 2010 and 2020 were analyzed in a systematic literature review using the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. Data regarding demographics, presentation, diagnosis, treatment, and outcome were collected.

Results

We identified four cases of SN-HPC in the nasal cavity in our institution and an additional 53 cases in previous reports. The mean age at the time of diagnosis was 59 years, with a 1.2:1 male to female ratio. SN-HPC mostly appears unilaterally, arising in the ethmoid sinus (42.1%). The most common presenting symptoms were epistaxis (47.3) and nasal obstruction (47.3%). Both computed tomography (CT) and magnetic resonance imaging (MRI) were required for diagnosis and for tailoring the treatment plan. Endoscopic surgical excision was used in 85.9% of the patients, and in 15.7%, an additional preoperative embolization was performed, which was associated with septal necrosis in one patient (2.6%). The recurrence rate was 7%.

Conclusion

Although previous reports attribute an aggressive tumoral behavior to SN-HPC, our experience and the literature review support a more indolent course with low recurrence rates following complete endoscopic resection. Preoperative embolization can be useful in certain cases, but due to potential complications, it should not be routinely indicated.

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Author notes

  1. Meir Warman and Adi Syn-Hershko contributed equally.

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel

    Meir Warman, Oded Cohen & Yonatan Lahav

  2. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Meir Warman, Oded Cohen & Yonatan Lahav

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Adi Syn-Hershko

  4. Department of Radiology, Invasive Radiology Unit, Kaplan Medical Center, Rehovot, Israel

    Yevgeny Tzipin

  5. Department of Otolaryngology, Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel

    Idit Tessler

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  1. Meir Warman
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Warman, M., Syn-Hershko, A., Cohen, O. et al. Sino-nasal hemangiopericytoma: a case series and systematic literature review. Eur Arch Otorhinolaryngol 279, 3989–3996 (2022). https://doi.org/10.1007/s00405-021-07239-w

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