Uncommon presentation of sinonasal glomangiopericytoma: a case report

Sinonasal glomangiopericytoma is a rare mesenchymal neoplasm of low malignant potential of the sinonasal tract, representing less than 0.5% of all tumors in this region. It is characterized by perivascular myoid differentiation and a propensity for local recurrence. We report a case of a 71-year-old South Asian male of Indian ethnicity from eastern India with a one-year history of left-sided nasal obstruction and episodic rhinorrhea. An acute intercurrent viral illness with lightheadedness led to a fall and marked epistaxis. Persistent and recurrent epistaxis over several weeks required further examination. Sequential imaging utilizing X-ray, CT, and contrast-enhanced MRI demonstrated a 7.3 × 4.0 × 1.8 cm enhancing vascular mass in the left nasal cavity, spreading to the nasopharynx. Histopathological examination subsequent to punch biopsy revealed a spindle cell neoplasm exhibiting a hemangiopericytomatous vascular pattern. Immunohistochemistry showed sinonasal glomangiopericytoma, exhibiting positive staining for SMA, MSA (focal), nuclear β-catenin, and Cyclin D1. The patient underwent endoscopic surgical excision of the mass with no intraoperative complication. This case highlights the importance of maintaining clinical vigilance for sinonasal masses in patients with recurrent epistaxis, despite initial presentations indicating benign causes. Subtle radiological findings should not be overlooked, and immunohistochemistry remains essential for definitive diagnosis of this rare tumor.