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lated, and firm appearance. 6,9 In contrast to GPC, inverted papil loma shows male predominance with a 2 to 3:1 male:female ratio and usually arises from maxillary sinus and lateral nasal wall. 9 Inhistol ogy, inverted papilloma exhibits squamous epithelial cells within the sinonasal tract, a distinguishing histological feature that sets it apart fromGPC. 10 Solitary fibrous tumors resemble GPC under micro scopic histology, but in contrast to GPC, solitary fibrous tumors are immunoreactive for CD34. The etiology of GPC is still unknown, but hypervascularity caused by hypertension, trauma, pregnancy, and the use of corticosteroids have been reported as possible causes. 6,7 We presumed that long-term hypertension without adequate control might be the possible etiology in this patient. Complete surgical resection with adequate margins remains the primary management strategy in patients with GPC. Recurrences were infrequently documented, with the majority of such in stances attributed to incomplete resection; notably, these recur rences manifested predominantly within 1 year after surgery. 4 Fur ther, owing to the bleeding tendency, preoperative angiographic embolization of GPC feeding vessels has been suggested to reduce bleeding volume during surgical resection. 1,4 Radiotherapy was re ported to be used in conjunction with surgery for local control of the disease. 4 Chemotherapy was additionally administered to patients presenting with metastatic disease, wherein the metastatic inci dence was documented to range from 5% to 10%. It is noteworthy that this observation predates the formal classification of GPC as a distinct clinical entity in 2005, thus potentially introducing a risk of diagnostic misclassification. 6 Because of its rarity, no formal guide lines have been published for sinonasal GPC, to our knowledge. Sinonasal GPC is a rare mesenchymal neoplasm of the sinona sal tract. It is typically indolent and has low malignant potential, with nasal obstruction and epistaxis being the most common clinical manifestations. The diagnosis is made through histology and im munohistochemical staining, and complete surgical resection with adequate margins remains the standard management. The patient was regularly followed up at our outpatient department after sur gery, and there was no tumor recurrence or decreased olfaction dur ing the 3-year follow-up period.

Grossly, GPC is submucosal in nature with a smooth surface and polypoid appearance and is sometimes difficult to differentiate from inflammatory polyps under endoscopy, leading to a challenging early diagnosis. 4 However, inflammatory nasal polyps usually present as bilateral nasal disease and seldom contain feeding vessels. For this patient, diagnosis was made through pathologic examination, which revealed a diffuse, subepithelial proliferation of bland, uniform, closely packed spindled cells surrounding capillaries with perivas cular hyalinization ( Figure2 ); thus, it was previously categorized as a hemangiopericytoma. 7 A positive immunohistochemical stain for smooth-muscle actin, cyclin D1, and nuclear expression of β-catenin can confirm the diagnosis of GPC. Grossly, both GPC and lobular cap illary hemangiomas are polypoid submucosal lesions with smooth surfaces. 7 However, it is still difficult to distinguish between these lesions because they usually present with a solid and soft texture. Histologically, lobular capillary hemangioma reveals lobular vascu lar proliferation consisting of vessels of capillary caliber. 8 On the other hand, inverted papilloma is mucosal origin with cerebriform, lobu Figure2. Hematoxylin-eosin staining of the tumor revealed sheetlike cellular proliferation of monomorphic ovoid to spindle tumor cells containing ectatic vascular spaces.

6 . Al-Jobory YM, Pan Z, Manes RP, Omay SB, Ikuta I. Sinonasal glomangiopericytoma. YaleJBiol Med . 2021;94(4):593-597. 7 . Dandekar M, McHugh JB. Sinonasal glomangiopericytoma. Arch Pathol Lab Med .2010; 134(10):1444-1449. doi:10.5858/2010-0233-CR.1 8 . Fountarlis AL, Lachanas V, Zacharouli K, Hajiioannou J, Kalogritsas N, Skoulakis C. Sinonasal lobular capillary hemangioma after continuous self-tests for COVID-19. Medeni Med J . 2022;37(4): 339-345. doi:10.4274/MMJ.galenos.2022.00533 9 . Eide JG, Welch KC, Adappa ND, Palmer JN, Tong CCL. Sinonasal inverted papilloma and squamous cell carcinoma. Cancers (Basel) .2022;14 (9):2195. doi:10.3390/cancers14092195 10 . Jewett FC III, Coulter MJ, Nelson BL. Sine qua non. Head Neck Pathol . 2021;15(3):950-954. doi:10.1007/s12105-021-01289-6

REFERENCES 1 . Gordon AJ, Papazian MR, Chow M, et al. Sinonasal glomangiopericytoma with prolonged postsurgical follow-up. J Neurol Surg Rep .2022;83 (3):e87-e89. doi:10.1055/a-1865-6801 2 . Obeidin F, Jennings LJ, Alexiev BA. Sinonasal glomangiopericytoma: a clinicopathologic study. Pathol Res Pract . 2019;215(5):983-987. doi:10.1016/ j.prp.2019.02.004 3 . Ghaloo SK, Dhanani R, Pasha HA, Wasif M, Fatima S, Ikram M. Glomangiopericytoma. JPak MedAssoc . 2020;70(12(B)):2469-2471. 4 . Asimakopoulos P, Syed MI, Andrews T, Syed S, Williams A. Sinonasal glomangiopericytoma. Ear Nose Throat J . 2016;95(2):E1-E5. doi:10.1177/ 014556131609500202 5 . Almarri FK, Alnatheer AM, Abuhaimed MK, Albathi AA, Alqahtani AQ, Tatwani T. A rare case of glomangiopericytoma in the nasal cavity. AnnMed Surg (Lond) . 2022;77:103685. doi:10.1016/j.amsu. 2022.103685

ARTICLE INFORMATION Author Affiliations: Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (Lee); Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (Ho, Fu); Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan (Fu). Corresponding Author: Chia-Hsiang Fu, MD, PhD, Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St, Guishan, Taoyuan 333, Taiwan (fufamily@cgmh.org.tw). Published Online: December 7, 2023. doi:10.1001/jamaoto.2023.3817 Conflict of Interest Disclosures: None reported. Additional Contributions: We thank the patient for granting permission to publish this information.

180 JAMA Otolaryngology–Head & Neck Surgery February 2024 Volume 150, Number 2 (Reprinted)

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