Abstract
It’s with great interest that we read the case report presented by Bolous et al concerning a “cavernous hemangioma” of the middle turbinate. 1 We believe there are a few things in this article worth discussing.
The word “cavernous hemangioma” is in our opinion improper not just from an ethimological standpoint.2,3 It was demonstrated histologically that what was known as “cavernous hemangioma” is not a proliferative lesion but rather a bony vascular malformation (in particular, a venous malformation).4,5
Similarly, the classification in “capillary,” “cavernous,” and “cellular” angioma has been long abandoned and we believe we should all try to avoid perpetrating it because it can be misleading. We believe we should rather try to adhere to the International Society for the Study of Vascular Anomalies (ISSVA) classification. 6
Regarding the preoperative study of the lesion, the key role of the magnetic resonance imaging (MRI) may be further elucidated. The aspect of the lesion presented is indeed compatible with a venous malformation. In case of doubt, a diffusion-weighted MRI study and an apparent diffusion coefficient (ADC) measurement may help a venous malformation usually shows a high ADC.7,8 As for the surgical management, we praise Bolous and colleagues for the choice of the approach and the realization.
Again, we believe that in the case of a venous malformation, we should pose our indications after taking into consideration the fact that it is not an angioma. That is, it is not a tumor. Consequently, absolute indications are bleeding, pain, or breathing issues. An increase in size over time may also be considered as an indication. Should we be radical in our intentions? Not necessarily. We want to share again our appreciations to Bolous and coworkers for publishing this singular case report. However, we are convinced that proper nosography may be really desirable in order to improve the knowledge in the fascinating world of vascular malformations.
