Sinonasal angiosarcoma: case report and literature review

BACKGROUND. Angiosarcoma is a neoplastic tumor that originates from endothelial cells, accounting for less than 2% of all sarcomas. The sinonasal localization of angiosarcoma is uncommon. It is a highly aggressive tumor with an increased risk of local recurrence. CASE REPORT. We present the case of a 24-year-old male patient with 1 month of left side epistaxis, left nasal obstruction, headache and left hemifacial paresthesia. The CT scan of the skull and paranasal sinuses performed with intravenous contrast showed a macronodular heterogenous tissue lesion, partially hyperdense spontaneously, iodophilic, with multiple vascular trajectories apparently of the arterial type, localised in the left maxillary sinus and ipsilateral nasal cavity. The first result from histopathological examination concluded for sinonasal angiofibroma with no signs of malignancy. Even if a wide resection was performed by external and endoscopic approach, a quite quick local recurrence appeared. After the second surgical resection of the tumor, the histopathological examination correlated with immunohistochemical tests and the clinical-imaging aspect concluded on sinonasal angiosarcoma. The proper treatment was delayed because of the histopathological examination misinterpretation. CONCLUSION. A thorough histopathological examination and immunohistochemistry have an important role for an adequate diagnosis of sinonasal angiosarcoma.