Preoperative Embolization for Sinonasal Angiosarcoma Optimized Intraoperative and Postoperative Outcomes: A Case Report.

BACKGROUND

Angiosarcoma is a rare and aggressive malignancy, representing less than 1% of head and neck cancers. Primary sinonasal angiosarcoma is exceedingly uncommon, with fewer than 40 cases reported. It carries a poor prognosis due to early recurrence and metastatic potential, and no standard treatment exists.

CASE REPORT: A 33-year-old male presented with a 2-year history of progressive nasal obstruction, later accompanied by epistaxis, facial pain, and headache. Imaging revealed a large vascular sinonasal mass extending into the nasopharynx, sphenoid, and ethmoid sinuses with bone destruction. Histopathology and immunohistochemistry confirmed sinonasal angiosarcoma. Preoperative embolization of feeding vessels achieved near-complete devascularization, enabling safe endoscopic resection with negative margins. The patient received adjuvant radiotherapy and has remained disease-free for more than 65 months, representing one of the longest reported survivals for this tumor.

CONCLUSION

Sinonasal angiosarcoma is a rare but aggressive tumor that should be included in the differential diagnosis of vascular sinonasal lesions. Preoperative embolization is an essential adjunct to reduce intraoperative bleeding and facilitate safe resection. Early diagnosis, multimodal treatment, and long-term follow-up are critical for improved outcomes.