Looks Like Cancer But Not? Maxillary Sinus Hemangioma: A Diagnostic Dilemma

Introduction Hemangiomas are benign vascular tumors frequently occurring in the head and neck region; however, involvement of the paranasal sinuses is rare. Among these, cavernous hemangiomas of the maxillary sinus are particularly uncommon and may mimic sinonasal malignancies clinically and radiologically due to their aggressive features. Common symptoms include unilateral nasal obstruction, epistaxis, and facial swelling, necessitating a comprehensive diagnostic and surgical approach. Case Report We report a case of a 68-year-old male with a two-year history of persistent right-sided nasal obstruction and blood-tinged discharge, accompanied by facial asymmetry and weight loss. Examination revealed a mass occupying the right nasal cavity, displacing the inferior turbinate. Imaging via contrast-enhanced CT showed a 6.2×5.7×3.7 cm enhancing soft tissue mass in the right maxillary sinus with bony erosion and extension into the nasal cavity, sphenoid sinus, and orbit, raising suspicion for malignancy. Pre-operative angiography confirmed vascular supply from the internal maxillary artery, and embolization was performed. The patient underwent a combined open and endoscopic right partial maxillectomy. Histopathology confirmed a diagnosis of cavernous hemangioma. Discussion Despite their benign nature, sinonasal hemangiomas—especially cavernous types—can cause aggressive bony destruction, mimicking malignancy. Imaging may reveal enhancing masses with areas of necrosis and hemorrhage, contributing to diagnostic challenges. Pre-operative embolization is a valuable adjunct to surgical resection to minimize intraoperative bleeding. Histologically, cavernous hemangiomas consist of dilated blood-filled vascular spaces with no cytological atypia, aiding in the differentiation from malignant lesions. Conclusion Maxillary sinus cavernous hemangiomas are rare and can present as a diagnostic dilemma due to their malignant-like features. A multidisciplinary approach involving endoscopy, imaging, embolization, and histopathological evaluation is critical for accurate diagnosis and effective management. Complete surgical excision remains the mainstay of treatment with favorable outcomes.