Clinical and Pathological Features of Angiomatous Nasal Polyps: A Report of Four Cases and Review of Literature

Abstract

Inflammatory or allergic sinonasal polyps are characterized by extensive vascular growth and ectasia with deposition of pseudoamyloid in 5% of cases. Angiomatous nasal polyp (ANP) is a relatively rare benign lesion, which may be misdiagnosed as a benign or malignant tumor. The characteristic pathological features of ANP are expanded angiogenesis, accumulation of extracellular amorphous eosinophilic substance, and atypical stromal cells. This report aimed to outline the histological differential diagnosis of ANP. Through a full histopathological examination, we studied biopsies and resected specimens from five patients who were diagnosed with ANPs, including one with facial deformity. Gross findings showed that tumors were firm in consistency, lobulated on the surface, and lined by partially ulcerated mucous membrane. Light microscopy showed clusters of widened, thin-walled blood vessels among congo red-negative eosinophilic substance with an area of necrosis and irregular stromal spindle cells. Presence of endothelial cell myofibroblasts were confirmed by electron microscopy and immunohistochemistry. This is a report of four cases which showed extreme examples of ANPs that was completely resected by endoscopic sinus surgery for all patients. A full histopathological examination is recommended to confirm the possible differential diagnoses for a better management plan.

Keywords: angiomatous nasal polyp (anp); diagnosis; endoscopic sinus surgery; vascular proliferation.

Figure 1. Shows lesion occupying left nasal cavity

Figure 2. Shows recurrent sinonasal polyposis

Figure 3. Shows bilateral partial opacification of ethmoid sinuses

Figure 4. Variable sized small and ectatic thin walled blood vessles , with foci of vascular congestion.

Figure 5. Angiectatic polyps with vascular thrombosis