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Looks Like Cancer But Not? Maxillary Sinus Hemangioma: A Diagnostic Dilemma

Introduction

Looks like cancer but not? maxillary sinus hemangioma: a diagnostic dilemma. Maxillary sinus hemangioma often mimics cancer, posing a diagnostic dilemma. This case details a rare cavernous hemangioma presenting aggressively, highlighting multidisciplinary diagnosis, embolization, and surgical management.

Abstract

Introduction Hemangiomas are benign vascular tumors frequently occurring in the head and neck region; however, involvement of the paranasal sinuses is rare. Among these, cavernous hemangiomas of the maxillary sinus are particularly uncommon and may mimic sinonasal malignancies clinically and radiologically due to their aggressive features. Common symptoms include unilateral nasal obstruction, epistaxis, and facial swelling, necessitating a comprehensive diagnostic and surgical approach. Case Report We report a case of a 68-year-old male with a two-year history of persistent right-sided nasal obstruction and blood-tinged discharge, accompanied by facial asymmetry and weight loss. Examination revealed a mass occupying the right nasal cavity, displacing the inferior turbinate. Imaging via contrast-enhanced CT showed a 6.2×5.7×3.7 cm enhancing soft tissue mass in the right maxillary sinus with bony erosion and extension into the nasal cavity, sphenoid sinus, and orbit, raising suspicion for malignancy. Pre-operative angiography confirmed vascular supply from the internal maxillary artery, and embolization was performed. The patient underwent a combined open and endoscopic right partial maxillectomy. Histopathology confirmed a diagnosis of cavernous hemangioma. Discussion Despite their benign nature, sinonasal hemangiomas—especially cavernous types—can cause aggressive bony destruction, mimicking malignancy. Imaging may reveal enhancing masses with areas of necrosis and hemorrhage, contributing to diagnostic challenges. Pre-operative embolization is a valuable adjunct to surgical resection to minimize intraoperative bleeding. Histologically, cavernous hemangiomas consist of dilated blood-filled vascular spaces with no cytological atypia, aiding in the differentiation from malignant lesions. Conclusion Maxillary sinus cavernous hemangiomas are rare and can present as a diagnostic dilemma due to their malignant-like features. A multidisciplinary approach involving endoscopy, imaging, embolization, and histopathological evaluation is critical for accurate diagnosis and effective management. Complete surgical excision remains the mainstay of treatment with favorable outcomes.

Review

This paper presents a compelling case of a maxillary sinus cavernous hemangioma, aptly titled "Looks Like Cancer But Not? Maxillary Sinus Hemangioma: A Diagnostic Dilemma." The authors effectively highlight the extreme rarity of paranasal sinus hemangiomas, particularly of the cavernous type within the maxillary sinus, and their remarkable ability to mimic aggressive sinonasal malignancies. The detailed account of a 68-year-old male presenting with chronic nasal obstruction, blood-tinged discharge, facial asymmetry, and even weight loss underscores the profound clinical overlap that can lead to diagnostic confusion, making this case report a valuable contribution to the literature on rare differential diagnoses in otolaryngology. The strength of this report lies in its comprehensive illustration of the diagnostic challenges encountered. The imaging findings, specifically the contrast-enhanced CT revealing a large, enhancing soft tissue mass with bony erosion and extensive infiltration into adjacent structures like the nasal cavity, sphenoid sinus, and orbit, were highly suggestive of malignancy. This underscores the critical need for a high index of suspicion and advanced diagnostic modalities. The paper further emphasizes the pivotal role of pre-operative angiography in delineating vascular supply and the subsequent embolization, which proved instrumental in minimizing intraoperative bleeding during the combined open and endoscopic partial maxillectomy. Ultimately, definitive diagnosis relied on meticulous histopathological examination, confirming the benign yet aggressive nature of a cavernous hemangioma. The "Discussion" section effectively synthesizes the key takeaways, reiterating that despite their benign histology, these lesions can cause significant bony destruction and present with aggressive features, necessitating a multidisciplinary approach. The authors successfully advocate for a comprehensive diagnostic pathway that integrates clinical assessment, advanced imaging, interventional radiology (embolization), and, crucially, histopathological confirmation to navigate these complex diagnostic dilemmas. This paper serves as an important reminder for clinicians to consider rare benign entities in the differential diagnosis of seemingly malignant sinonasal masses, ensuring accurate diagnosis and appropriate surgical management for favorable patient outcomes.

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