Clinical and pathological characteristics of organized hematoma

Abstract

Objective. To study the clinical and pathological characteristics of patients with organized hematoma with malignant features in maxillary sinuses. Subjects and Methods. This was a retrospective study of five patients who were treated surgically for organized hematoma. The preoperative CT and MRI findings were studied clinically. The expressions of CD31, CD34, and periostin in surgical samples were investigated by immunohistochemistry. Results. The clinical features of organized hematoma, such as a mass expanding from the maxillary sinus with bone destruction, resembled those of maxillary carcinoma. However, CT and MRI provided sufficient and useful information to differentiate this condition from malignancy. Surgical resection was the first-line treatment because of the presence of a firm capsule. Characteristic histopathological findings were a mixture of dilated vessels, hemorrhage, fibrin exudation, fibrosis, hyalinization, and neovascularization. The expressions of periostin, CD31, and CD34 were observed in organized hematoma of the maxillary sinus. Conclusion. The expressions of periostin, CD31, and CD34 were observed in organized hematoma of the maxillary sinus. Organized hematoma is characterized pathologically by a mixture of bleeding, dilated vessels, hemorrhage, fibrin exudation, fibrosis, hyalinization, and neovascularization. CT and MRI show heterogeneous findings reflecting a mixture of these pathological entities.

Figure 1

A 36-year-old female had a 2-month history of recurrent epistaxis. Initial coronal contrast-enhanced computed tomography scan of the paranasal sinuses revealed a 36 × 24 mm heterogeneous enhanced mass in the right maxillary sinus. The central region of the mass was strongly enhanced. Compression and thinning of the lateral wall of the right nasal cavity were observed (case III).

Figure 2

A 36-year-old female had a 2-month history of recurrent epistaxis. (a) Initial T1-weighted magnetic resonance image before treatment, showing a slightly low intensity in the central region of the mass (coronal view). (b) Initial T2-weighted magnetic resonance image before treatment, showing a heterogeneous mass. The central portion had high signal intensity, and the surrounding region had lower signal intensity than the central portion. The paranasal mucosa was thickened but kept its structure (axial view). (c) Initial Gd-DTPA magnetic resonance image before treatment, showing that the central portion was strongly enhanced. The surrounding region was less enhanced than the central portion. The thickened mucosa of the paranasal sinus was also strongly enhanced (axial view).

Figure 3

Representative pathological findings of organized hematoma. Nonneoplastic tissue with hemorrhage, fibrin exudation, and hyalinization was observed. (HE, original magnification ×100).

Figure 4

Immunohistochemical staining for CD31 and CD34 in organized hematoma (original magnification ×100). CD31-positive cells were observed in the organized hematoma, and dilated vessels were found (a). CD34-positive cells were observed in the organized hematoma (b). (Immunostaining, original magnification ×100 and ×200.)

Figure 5

Immunohistochemical staining for periostin in organized hematoma (original magnification ×100). The expression of periostin was observed in the organized hematoma.