Giant hypervascular lesion of the sinonasal tract invading the anterior skull base and orbit: a puzzling case.

The sinonasal tract may be involved in a wide variety of hypervascular lesions, either benign or malignant, and differential diagnosis may be challenging. We present the case of a 26-year-old man with an aggressive ethmoid hypervascular mass invading the anterior skull base and orbit. Because of massive intraoperative bleeding and difficult dissection of the lesion from the periorbita, the planned cranioendoscopic approach had to be converted into a standard craniofacial resection by a combined Lynch and coronal incision. The definitive diagnosis was consistent with lobular capillary hemangioma associated with intravascular papillary endothelial hyperplasia. Two years after surgery, the patient is free of disease. Lobular capillary hemangioma is a hypervascular lesion that may involve the sinonasal tract. The case presented herein is exceptional, both in the presentation and in the difficulties encountered in diagnosis and treatment, because of the concurrence of lobular capillary hemangioma and intravascular papillary endothelial hyperplasia.