ArticlePDF Available

Angiomatous Polyp Originating From the Inferior Turbinate: A Variant of the Sinonasal Polyp

Authors:
Hyung-Bon Koo
Hyung-Bon Koo
Hyung-Bon Koo
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Jae-Hoon Lee
Jae-Hoon Lee
Jae-Hoon Lee
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Download full-text PDF
Read full-text
Download citation

Abstract

Angiomatous polyps are an uncommon subtype of sinonasal polyps, characterized by extensive vascular proliferation and ectasia. The authors report the first case of angiomatous polyp originating from the inferior turbinate, which is a variant of the sinonasal polyp.
Available via license: CC BY-NC 4.0
Content may be subject to copyright.
Clinic
Angiomatous Polyp Originating From the
Inferior Turbinate: A Variant of the
Sinonasal Polyp
Hyung-Bon Koo, MD
1
, and Jae-Hoon Lee, MD
1
Significance Statement
Angiomatous polyps are an uncommon subtype of sinonasal polyps, characterized by extensive vascular proliferation and ectasia.
The authors report the first case of angiomatous polyp originating from the inferior turbinate, which is a variant of the sinonasal
polyp.
A 65-year-old man with a 6-month history of a left-sided, slow,
progressive nasal obstruction was referred to our hospital.
Nasal endoscopy revealed a polypoid nasal mass obstructing
the left nasal floor (Figure 1). The mass appeared to have
originated from the left inferior turbinate. The right nasal cav-
ity and nasopharynx appeared normal. Allergic skin test was
negative. There were no other relevant findings. Coronal com-
puted tomography (CT) revealed a soft tissue density in the left
nasal cavity (Figure 2). We suspected an inverted papilloma or
a simple polypoid mass and decided to perform an excisional
biopsy for confirmation.
The mass was removed endoscopically under local anesthesia.
It originated from the middle and posterior portion of the inferior
turbinate. During the removal of the mass, the patient exhibited a
more severe bleeding than we had expected. To control the bleed-
ing, we used a suction coagulator and packing. The patient had a
mild intermittent bleeding for 3 days after the procedure.
1
Department of Otolaryngology, Institute of Wonkwang Medical Science,
Wonkwang University School of Medicine, Iksan, Chonbuk, Korea.
Received: April 27, 2021; accepted: May 03, 2021
Corresponding Author:
Jae Hoon Lee, MD, Department of Otolaryngology, Wonkwang University
School of Medicine 18, Gobong-ro 24-gil, Iksan-si, Jeollabuk-do 54538,
Republic of Korea.
Email: leejaehoon64@gmail.com
Figure 1. Endoscopy revealed a mass in the left nasal cavity.
IT indicates inferior turbinate; S, septum.
Figure 2. A coronal computed tomography (CT) scan revealing soft
tissue density in the left nasal cavity.
Ear, Nose & Throat Journal
1–2
ªThe Author(s) 2021
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/01455613211019709
journals.sagepub.com/home/ear
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License
(https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission
provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
The mass comprised an inflammatory polyp and numerous
small and large vessels in a fibrous stroma (Figure 3). On the
basis of the tumor’s histopathology, a diagnosis of angiomatous
polyp (AP) was made. The postoperative course was unevent-
ful, and the patient exhibited no further symptoms.
Angiomatous polyps are an uncommon subtype of sinonasal
polyps, characterized by extensive vascular proliferation and
ectasia.
1
The most common site of origin of sinochoanal polyps
with angiomatous changes is the maxillary sinus.
2,3
The clin-
ical, radiological, and pathological findings of an AP obstruct-
ing the choana may be confused with those of a vascular
neoplasm, including juvenile nasopharyngeal angiofibroma.
4
Imaging studies such as CT and magnetic resonance imaging
studies may be helpful in the differential diagnosis of juvenile
nasopharyngeal angiofibromas and APs obstructing the naso-
pharynx. In the preoperative differential diagnosis of these
cases, inverted papilloma is among the most frequently
considered conditions.
5
In our case, inverted papilloma could
not be excluded on the basis of the clinical or radiological study
results alone. In this case, we strongly suspected an inverted
papilloma or a simple polypoid mass after examining the
patient during his first visit to our hospital. To our knowledge,
APs originating from the inferior turbinate have not been
reported previously. The authors report the first case of AP
originating from the inferior turbinate, which is a variant of
the sinonasal polyp.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
ORCID iD
Jae-Hoon Lee https://orcid.org/0000-0002-0856-8173
References
1. Yfantis HG, Drachenberg CB, Gray W, Papadimitriou JC.
Angioectatic nasal polyps that clinically simulate a malignant pro-
cess: report of two cases and review of the literature. Arch Pathol
Lab Med. 2000;124(3):406-410.
2. Idris AI, Ramli RR, Sachlin IS. Angiomatous antrochoanal polyps:
challenge in diagnosis. Egypt J Ear Nose Throat Allied Sci. 2017;
18(2):137-139.
3. Park CS, Noh H, Bae SC, Park YJ. Antrochoanal polyp’s variant,
the angiomatous nasal polyp: a case report. Korean J Otolaryngol
Head Neck Surg. 2006;49(4):443-446.
4. Batsakis JG, Sneige N. Choanal and angiomatous polyps of the
sinonasal tract. Ann Otol Rhinol Laryngol. 1992;101(7):623-625.
5. Sheahan P, Crotty PL, Hamilton S, Colreavy M, McShane D.
Infarcted angiomatous nasal polyps. Eur Arch Otorhinolaryngol.
2005;262(3):225-230.
Figure 3. The tumor comprises an inflammatory polyp and numerous
small and large vessels in a fibrous stroma (40).
2Ear, Nose & Throat Journal
Sinonasal Angiomatous Polyp: A Case Report and Review of Literature
Article
Sinonasal angiomatous polyp (SAP) is a benign pseudoneoplastic lesion rarely reported in the literature. It may be misdiagnosed as a malignant neoplasm due to its aggressive features of bone erosion clinically or on imaging. We report the case of a 43-year-old woman with a 3 month history of unilateral nasal obstruction with recurrent epistaxis. Nasal endoscopy showed polypoid nasal mass occupying the left nasal cavity. Imaging was suggestive of malignant vascular tumor. The patient underwent surgical excision after embolization. Histopathology concluded to the diagnosis of SAP.
View
Angiomatous antrochoanal polyps: Challenge in diagnosis
Article
Full-text available
  • Jan 2017
Epistaxis is a common complaint seen in the younger population. Its etiology is typically from the anterior nares, although we present a case of epistaxis from an uncommon source. Diagnosis of bleeding nasal mass is varied from benign to malignant lesions. Angiomatous antrochoanal polyps (AAP) are one of the causes but it is rare and the diagnosis is challenging as it mimic other nasal mass especially nasopharyngeal angiofibroma (NA). There are a lot of similarities of clinical presentations, between imaging and histopathological findings between these two which made the diagnosis even more difficult. A correct diagnosis is extremely important as although they have similar clinical presentations, the management is different. Here we report a case of a young lady with significant epistaxis which was initially diagnosed as NA but with a final revised diagnosis of AAP.
View
Angiectatic Nasal Polyps That Clinically Simulate a Malignant Process
Article
  • Mar 2000
Background.—Approximately 5% of inflammatory or allergic sinonasal polyps develop extensive vascular proliferation and ectasia with deposition of pseudoamyloid. These so-called angiectatic nasal polyps (ANPs) can grow rapidly and exhibit an aggressive clinical behavior that could simulate malignancy preoperatively. Objective.—To systematically address the differential histologic diagnosis of ANPs. Methods.—We evaluated by light microscopy, immunohistochemistry, and electron microscopy biopsy and resection specimens from 2 large ANPs (8 and 10 cm in diameter) that presented in 2 adult men with life-threatening epistaxis and facial deformity, respectively. Results.—The tumors were firm, lobulated, and covered by smooth, partially ulcerated mucosa. Histologically, clusters of dilated, thin-walled blood vessels embedded in pools of Congo red–negative eosinophilic material, associated with patchy necrosis and atypical stromal spindle cells, were seen. Electron microscopy and immunohistochemistry (CD34, factor VIII) confirmed the endothelial nature of the cells lining the spaces, whereas the atypical stromal cells were classified as myofibroblasts. Conclusions.—These 2 cases represent extreme examples of ANPs that clinically simulate a malignant process. Awareness of the histological features of ANPs should prevent confusion of such lesions with other vascular or spindle cell lesions of the nasopharynx that would require different treatment and carry a different prognosis.
View
Choanal and Angiomatous Polyps of the Sinonasal Tract
Article
  • Aug 1992
Choanal and angiomatous polyps can be distinguished from ordinary sinonasal polyps by either a distinctive clinical presentation (choanal) or the histopathologic appearance (angiomatous). Nearly all choanal polyps arise within paranasal sinuses, with the antrochoanal polyp the most common. The angiomatous polyp is most often a secondary change in a choanal polyp and can be mistaken for vascular neoplasms, eg, angiofibroma.
View
Angiectatic nasal polyps that clinically simulate a malignant process: Report of 2 cases and review of the literature
Article
  • Apr 2000
Approximately 5% of inflammatory or allergic sinonasal polyps develop extensive vascular proliferation and ectasia with deposition of pseudoamyloid. These so-called angiectatic nasal polyps (ANPs) can grow rapidly and exhibit an aggressive clinical behavior that could simulate malignancy preoperatively. To systematically address the differential histologic diagnosis of ANPs. We evaluated by light microscopy, immunohistochemistry, and electron microscopy biopsy and resection specimens from 2 large ANPs (8 and 10 cm in diameter) that presented in 2 adult men with life-threatening epistaxis and facial deformity, respectively. The tumors were firm, lobulated, and covered by smooth, partially ulcerated mucosa. Histologically, clusters of dilated, thin-walled blood vessels embedded in pools of Congo red-negative eosinophilic material, associated with patchy necrosis and atypical stromal spindle cells, were seen. Electron microscopy and immunohistochemistry (CD34, factor VIII) confirmed the endothelial nature of the cells lining the spaces, whereas the atypical stromal cells were classified as myofibroblasts. These 2 cases represent extreme examples of ANPs that clinically simulate a malignant process. Awareness of the histological features of ANPs should prevent confusion of such lesions with other vascular or spindle cell lesions of the nasopharynx that would require different treatment and carry a different prognosis.
View
Infarcted angiomatous nasal polyps
Article
  • Apr 2005
Angiomatous nasal polyps are a rarely reported subtype of inflammatory sinonasal polyps that are characterized by extensive vascular proliferation and ectasia. Compromise of their vascular supply may occasionally lead to infarction, resulting in clinical, radiological and pathological features that simulate a neoplastic process. In the present paper, the salient characteristics of this unusual entity are described. The clinical, radiological and pathological features of two patients with infarcted angiomatous nasal polyps are presented. Grossly, the polyps had an unusual inhomogenous appearance and texture and were associated with a foul odor. CT findings included bony expansion and destruction. MRI findings included markedly inhomogenous contrast enhancement on T1-weighted images. Histopathologically, both cases showed abundant vascular ectasia, with widespread intraluminal thrombosis and necrosis. Recanalization and reparative changes were also present. Angiomatous nasal polyps are poorly documented in the literature. Although entirely benign, they may simulate neoplastic processes, thus awareness of their existence is of considerable importance.
View
Antrochoanal polyp's variant, the angiomatous nasal polyp: a case report
  • Jan 2006
  • 443-446
  • C S Park
  • H Noh
  • S C Bae
  • Y J Park
Park CS, Noh H, Bae SC, Park YJ. Antrochoanal polyp's variant, the angiomatous nasal polyp: a case report. Korean J Otolaryngol Head Neck Surg. 2006;49(4):443-446.