PMC5124446_01
(a) shows axial and (b) shows coronal CT images. Both show a soft tissue mass occupying the left nasal vestibular area.
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CT scan of paranasal sinuses showed 3.4 x 2.5 x 1.9 cm mass localized to the anterior part of the left side of the nasal cavity with no extension to the choana or to the paranasal sinuses (Figures 1(a) and 1(b)).
MRI of nose and paranasal sinuses showing a highly vascular mass occupying the left nasal vestibular area. (a) shows T1 coronal view, (b) shows T1 postcontrast axial view, and (c) shows a T2 sagittal view.
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MRI (done to rule out hypervascularity of the mass before surgical intervention) showed a hypervascular mass in the same previously described position (Figures 2(a), 2(b), and 2(c)). 24 hours before the surgery, angiography was done which showed hypervascular left side nasal mass supplied by the distal branches of the left internal maxillary artery and distal branches of the left facial artery.
(a) Angiography showing hypervascular nasal mass supplied by the distal branches of the left internal maxillary artery and distal branches of the left facial artery. (b) The mass after embolization of the internal maxillary artery.
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Selective embolization was done, to decrease the intraoperative bleeding, with polyvinyl alcohol temporary occlusive particles (PVA), which reduced 85% of the blood flow to the area (Figures 3(a) and 3(b)).
Richly vascular lesion which has variable-sized thin-walled vessels surrounded by a fibroblastic stroma. The vessels have a single endothelial cell lining without a muscularis layer (H&E 20x).
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The histomorphology and immunohistochemical staining profile supported the diagnosis of angiofibroma (Figure 4).