Glomangioma of the nasal cavity: a case report from Pakistan

Abstract

Glomus tumors are rare benign mesenchymal neoplasms arising from modified smooth muscle cells of the glomus body, primarily found in subungual regions of distal extremities. Involvement of the nasal cavity, particularly in the form of glomangiomas, is exceptionally rare and limited to case reports. We present a case of a 59-year-old male with a long-standing history of nasal obstruction. Clinical and radiological evaluations revealed a vascular mass originating from the right maxillary sinus and extending into the nasal cavity. The lesion was endoscopically excised and found intraoperatively to be unusually vascular. Histopathological examination confirmed the diagnosis of glomangioma. The patient has remained recurrence-free over four years of follow-up. Intranasal glomangiomas are exceptionally rare and may mimic more common nasal lesions. Histopathology and immunohistochemistry are crucial for accurate diagnosis. Surgical excision appears to offer favorable outcomes, with recurrence largely attributed to incomplete resection, though conclusions remain limited by the rarity of this entity.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s13256-026-06235-0.

Introduction

A glomus body is a specialized form of arteriovenous anastomoses that helps to function in thermoregulation [1]. Occasionally, this body may become hyperplastic or hamartomatous, resulting in the formation of a benign tumor of the mesenchymal origin – a glomus tumor [2]. This tumor, described first by William Woods in 1812 [3], is a rare soft tissue tumor resulting from the proliferation of undifferentiated smooth muscle cells. These tumors may be further subdivided based on histopathology: solid glomus tumor, glomangioma, and glomangiomyoma [4].

Glomus tumors usually present as painful nodules, appearing on the skin of distal extremities where most glomus bodies are present, with the most common presentation being in the subungual regions of the fingers [5]. However, the involvement of head and neck region is exceptionally rare for a glomus tumor and is limited to case reports only. Among these, glomangiomas—the second most common variant characterized by prominent vascularity—constitute the majority of reported cases in the nasal and paranasal cavities [6].

We present a case report of a 59-year-old male who presented with complaints of long-standing nasal obstruction due to right nasal cavity mass and was ultimately diagnosed with an intranasal glomangioma. To the best of our knowledge, this is the first case of this rare entity being reported from Pakistan.

Case report

A 59-year-old male with no known comorbidities presented to the clinic with a primary complaint of long-standing nasal obstruction. The growth was otherwise asymptomatic, except for secondary sinusitis, likely due to the occlusion of the right ostiomeatal complex. Clinical examination revealed a mass in the right nasal cavity, occupying both the inferior and middle meatuses. A computed tomography (CT) scan of the paranasal sinuses confirmed its origin from the antrum of the right maxillary sinus, with extension into the right nasal cavity and posteriorly reaching the left ostiomeatal complex via the nasopharynx (Fig. 1). While no bone erosion was observed, there was clear evidence of bone remodeling. The radiological appearance suggested a non-neoplastic lesion resembling a large antrochoanal polyp. Additional findings included bilateral ostiomeatal complex obstruction and acute right maxillary sinusitis, indicated by air-fluid levels.

Fig. 1.

A lobulated soft tissue enhancing mass arising from the right maxillary antrum with extension into right nasal cavity and posterior nasopharynx

The mass was excised via endoscopic resection. Intraoperatively, it appeared fleshier than a typical polyp and bled profusely upon manipulation. A biopsy was performed, and after achieving hemostasis, complete removal was achieved using a debrider. The right ostia were widened, and the sinus was irrigated via endoscopic clearance. Nasal packing was placed, and the patient was kept under observation. Notably, removal of the nasal packing as per protocol led to surgical site bleeding, which required additional packing with ribbon gauze and was successfully removed two days later.

Histopathological analysis of the excised 2 × 1.2 cm mass, which had a tan-pink cut surface, revealed polypoid tissue lined by pseudostratified ciliated columnar epithelium. The lesion consisted of round to elongated clusters of cells interspersed with thin-walled blood vessels. The neoplastic cells exhibited moderately pale to clear cytoplasm, vesicular nuclei, and inconspicuous nucleoli, with no evidence of atypical mitosis. Immunohistochemical analysis was positive for alpha smooth muscle actin (ASMA) but negative for CD34 and Cytokeratin AE1/AE3. These findings confirmed the diagnosis of a benign glomangioma.

The patient remained complication-free during follow-up visits, with no evidence of recurrence over the past four years.

Discussion

Glomus tumors are rare, accounting for less than 2% of soft tissue tumors [7]. As vascular neoplasms, they typically present as subcutaneous nodules with red, purple, or blue discoloration [8]. These tumors most commonly arise in distal locations, such as the fingertips and subungual regions, due to the high concentration of glomus bodies in these areas [5]. However, they can also occur sporadically in other sites, including intravascular, respiratory, and gastrointestinal locations [9]. Glomangiomas in the head and neck region are exceptionally rare, often presenting as polypoid masses in the nasal septum, nasal cavity, or paranasal sinuses [10]. Clinically, they may manifest as nasal obstruction, rhinorrhea, and epistaxis, though our patient presented only with nasal obstruction and was otherwise asymptomatic.

As of the most recent literature available at the time of writing, fewer than 50 cases have been documented. Prior reports indicate a female predominance with a 2:1 ratio and a higher incidence in middle-aged individuals, though cases have been documented across all adult age groups [11]. Our patient, a 59-year-old male, falls within the typical demographic.

Differentiating glomus tumors from other similar neoplasms, such as paragangliomas, is crucial. Paragangliomas, often misnamed as "glomus tympanicum" or "glomus jugulare," originate from neural crest cells, whereas glomus tumors arise from smooth muscle cells. Immunohistochemical staining helps distinguish these entities; paragangliomas stain positive for neuroendocrine markers like synaptophysin, chromogranin A, and S100 [12], while glomus tumors stain negative for these markers but positive for smooth muscle actin (SMA). Angiosarcomas represent another differential consideration given their vascular nature and potential to present as nasal masses. However, angiosarcomas typically demonstrate marked cytological atypia, necrosis, and destructive growth patterns, and stain positive for endothelial markers such as CD31 and CD34, distinguishing them from the bland cytology and CD34 negativity seen in glomus tumors. Additionally, glomus tumors express vimentin and collagen type IV, with CD34 positivity in fewer than 20% of cases [13].

Histologically, glomus tumor cells are round or ovoid, with pale or eosinophilic cytoplasm, and are typically surrounded by blood vessels [14]. Our patient's pathological findings were consistent with this description, and immunohistochemical staining confirmed α-SMA (ASMA) positivity, establishing the diagnosis of glomangioma. Surgical excision remains the primary treatment, with a low recurrence rate, mainly attributed to incomplete resection [15]. In this case, no recurrence has been observed in four years of follow-up, underscoring the excellent prognosis.

This report has several limitations inherent to its case report design. First, the rarity of intranasal glomangiomas means that our findings and outcomes cannot be generalized, and broader conclusions about prognosis, recurrence, and management must be drawn cautiously. Second, preoperative imaging did not suggest a vascular neoplasm, which highlights the diagnostic challenge these lesions pose but also underscores the risk of unanticipated intraoperative bleeding, a limitation in surgical planning that clinicians should be aware of. Finally, while four years of follow-up without recurrence is encouraging, longer surveillance data would be needed to make definitive statements about the durability of surgical cure.

In conclusion, glomus tumors are rare neoplasms, with glomangiomas of the nasal cavity being exceptionally uncommon. Despite their rarity, they should be considered in the differential diagnosis of vascular nasal masses. Accurate diagnosis relies on histopathological and immunohistochemical analysis to distinguish them from other soft tissue tumors, particularly paragangliomas and angiosarcomas. Our case highlights the importance of recognizing this entity in atypical locations and reinforces the favourable prognosis following appropriate management.

Author contributions

All authors contributed to the study conception and design. The first draft of the manuscript was written by Mohammad Shahzaib Qadir, Reyan Hussain Shaikh, and Muhammad Ozair Awan. Muhammad Sohail Awan supervised the project. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Data availability

Data available on reasonable request.

Declarations

Ethics approval and consent to participate

Our institution does not require ethical approval for reporting individual cases or case series.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare no competing interests.