Mixed Hemangioma Concurrence with Giant Concha Bullosa Arising from the Middle Concha

A 71-year woman presented with persistent epistaxis for two years without a history of nasal trauma or surgery. On physical examination, a red-purple mass obstructing the entrance of the right nasal passage was observed. The nasal septum was deviated to the left and a large concha bullosa (CB) was detected on the same side. Contrast-enhanced maxillofacial computed tomography (CT) revealed a 2.5 cm in diameter, heterogeneous, and irregular soft tissue density mass connected to the middle concha and the anterior septum. A large CB, 3.5 cm in diameter, originating from the middle concha, was also observed. The CB was adjacent to the soft tissue density mass (Figure 1a). No mass was detected in paranasal sinus CT, which was performed three years ago, due to symptoms possibly associated with sinusitis, except for the CB with the same size. The mass and CB were removed totally and submitted to the pathology laboratory with preliminary diagnoses of hemangioma, pyogenic granuloma, and soft tissue malignancy. Histopathological examination of the mass revealed numerous, thin-walled, erythrocyte-containing cavernous, and capillary vessels in a polypoid mucosa covered by respiratory epithelium (Figure 1b). The epithelium showed localised squamous metaplasia. Focal hyalinisation and foci of dystrophic calcification were also observed. Histopathological examination of CB showed cystic cavities lined with the respiratory epithelium. The cystic cavities were surrounded by an edematous and inflamed fibrous stroma containing seromucous glands and numerous vascular structures. The outer respiratory epithelium also showed localised squamous metaplasia (Figure 1c). Vascular structures were positively stained with CD31 and CD34 in hemangioma (Figure 1d)...