Angiectatic sinonasal polyps: A clinicopathological analysis of 20 cases

Angiectatic sinonasal polyps (ANPs) are a rare but clinically significant entity in sinonasal pathology, often resembling neoplasms and complicating diagnostic accuracy. Due to their potential for serious complications, ANPs warrant closer investigation. This study aims to explore the clinicopathological characteristics of ANPs, emphasizing their diagnostic challenges and identifying key features for accurate identification. Among 189 inflammatory sinonasal polyps evaluated over 8 years, 20 cases (10.6%) were ANPs, predominantly affecting males (70%) and patients older than 30 years (65%). The left maxillary sinus was most involved (75%). Nasal obstruction (100%), rhinorrhea (90%), bleeding on touch (80%), and rapid growth (70%) were frequent. Radiology showed expansile lesions with bone remodeling (100%) and erosion (30%). Histopathology revealed vascular proliferation (100%), stromal edema and chronic inflammation (95%), atypical fibroblasts (80%), and infarction and squamous metaplasia (50%). All were treated by surgical excision; despite intraoperative bleeding (55%), no recurrences were observed during 6-month follow-up, indicating excellent prognosis. ANPs are a diagnostic challenge within the broader category of SNPs, often presenting with features that mimic malignancy. However, they exhibit a distinctive histopathological profile, characterized by vascular proliferation and eosinophilic matrix deposition, which can aid in their diagnosis and guide treatment strategies. • Angiectatic sinonasal polyps often mimic neoplasms clinically and radiologically. • Retrospective analysis identified 20 ANPs among 189 inflammatory sinonasal polyps. • Male predominance with frequent bleeding, rapid growth, and bone erosion • Key histology shows irregular vascular proliferation and eosinophilic matrix. • Accurate histopathology prevents misdiagnosis and unnecessary aggressive treatment.