Lobular capillary hemangiomas: Case report and review of literature of vascular lesions of the nasal cavity

doi:10.1016/j.amjoto.2017.02.004

American Journal of Otolaryngology

Volume 38, Issue 3, May–June 2017, Pages 363-366

https://doi.org/10.1016/j.amjoto.2017.02.004 Get rights and content

Abstract

Vascular tumors of the nasal cavity can represent a variety of pathologies. In this case report, we discuss two patients presenting with a large vascular lesion occupying the nasal cavity. Significant bleeding was encountered during the initial attempts for endoscopic surgical resection. One lesion was successfully excised following preoperative embolization while a second following sphenopalatine artery vascular ligation. In both cases, final pathology showed lobular capillary hemangioma (LCH). We present a literature review and discussion of LCH and other vascular tumors that present in the nasal cavity. In addition, we discuss the utility of pre-resection vascular control of these tumors.

Introduction

There are numerous types of vascular tumors that can develop in the nasal cavity. Nasal tumors often present with non-specific characteristics of nasal congestion, rhinorrhea, epistaxis, or anosmia. Less common manifestations include vision changes, headaches, local swelling or pain. Imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are valuable for surgical planning, but histology is needed for definitive diagnosis. Recommended treatment varies based on the presenting pathology.

Histology includes lobular capillary hemangioma (LCH), hemangiopericytoma, angiofibroma, leiomyoma, glomus tumor, angiosarcoma and kaposi's sarcoma [1]. In this paper, we discuss two cases of a patient presenting with a nasal cavity mass with final pathology showing LCH as well as provide a review of vascular nasal cavity tumors included in the differential diagnosis.

Section snippets

Case report 1

A 60 year-old female presented to clinic with 4 months of left nasal passage obstruction. She had been experiencing intermittent nasal bleeding that occurred with manipulation of the left nasal cavity. She also endorsed posterior nasal drainage and significantly decreased sense of smell. On exam, there was complete obstruction of the left nasal cavity with a vascular appearing mass (Fig. 1).

A CT scan was obtained demonstrating a large nasal cavity mass with remodeling of the surrounding

Case report 2

A 36 year-old female presented with 6 months left sided nasal airway obstruction and left maxillary region pressure with recurrent episodes of sinusitis. The patient was initially taken to the operating room by a community otolaryngologist for resection. Unfortunately, significant intraoperative bleeding was encountered and the procedure was aborted. Tissue specimen sent from this procedure was consistent with a benign vascular lesion. The patient was referred to our institution for further care.

Vascular tumors of the nasal cavity

Nasal LCHs are benign growths that can occur in the nasal cavity and paranasal sinuses. They arise from vascular endothelial cells and have capillaries arranged in a characteristic lobular pattern [2]. Historically, these lesions were referred to as pyogenic granulomas, but this is a misnomer given that they are neither infectious nor granulomatous. They are the most common vascular tumor of the nasal cavity [2]. These tumors can often grow to a large size and can sometimes be misdiagnosed as

Conclusion

Lobular capillary hemangiomas are the most common vascular tumor arising in the nasal cavity. However, there are numerous other histologies that must be included in the differential when evaluating a vascular nasal tumor. Tissue diagnosis is critical as this will, ultimately, guide treatment and management. Preoperative embolization and vascular ligation can be a valuable tool in select patients with nasal vascular tumors.

Conflict of interest

There are no conflicts of interest of financial disclosures to report.

References (57)

R. Derkenne et al.
Nasal cavity lobular capillary hemangioma due to insect sting
Eur Ann Otorhinolaryngol Head Neck Dis
(2012)
L. Garcia-Rodriguez et al.
Nasal septal angiofibroma, a subclass of extranasopharyngeal angiofibroma
Am J Otolaryngol
(2012)
J.F. Carrillo et al.
An audit of nasopharyngeal fibromas
Eur J Surg Oncol
(2007)
A.W. Gaut et al.
Invasive glomus tumor of the nasal cavity
Am J Otolaryngol
(2005)
R.D. Cullen et al.
Intranasal glomangioma
Am J Otolaryngol
(2000)
F. Es-Sbissi et al.
Sinonasal angiosarcoma
Eur Ann Otorhinolaryngol Head Neck Dis
(2015)
H.U. Jang et al.
Direct intratumoral embolization of intranasal vascular tumors
Auris Nasus Larynx
(2013)
G. Lin et al.
Surgical management of severe epistaxis
Otolaryngol Clin N Am
(2016)
M. Cassano et al.
Endoscopic intraoperative control of epistaxis in nasal surgery
Auris Nasus Larynx
(2010)
J. Bizakis et al.
Vascular tumours of the nasal septum
J Otolaryngol
(2002)

S.E. Mills et al.

Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes

Am J Surg Pathol

(1980)

C. Delbrouck et al.

Lobular capillary haemangioma of the nasal cavity during pregnancy

J Laryngol Otol

(2011)

L.L. Gregorio et al.

Lobular capillary hemangioma formation: an unusual complication of submucous resection with power instrumentation of the inferior turbinate

Laryngoscope

(2015)

P. Patil et al.

Nasal lobular capillary hemangioma

J Clin Imaging Sci

(2013)

D.G. Lee et al.

CT features of lobular capillary hemangioma of the nasal cavity

AJNR Am J Neuroradiol

(2010)

T. Vikneswaran et al.

Sino-nasal hemangiopericytoma—a rare tumor

Med J Malays

(2005)

S. Varhney et al.

Sino-nasal haemangiopericytoma

Indian J Otolaryngol Head Neck Surg

(2004)

R. Marianowski et al.

Nasal haemangiopericytoma: report of two cases with literature review

J Laryngol Otol

(1999)

X. Wang et al.

Combined therapy against recurrent and intracranial invasion of sinonasal hemangiopericytoma: a case report

Oncol Lett

(2015)

L. Thompson et al.

Sinonasal-type hemangiopericytoma: a clinicopathologic and immunophenotypic analysis of 104 cases showing perivascular myoid differentiation

Am J Surg Pathol

(2003)

J.P. Windfuhr et al.

Extranasopharyngeal angiofibroma: etiology, incidence and management

Acta Otolaryngol

(2004)

D. Ye et al.

Analysis of factors in successful nasal endoscopic resection of nasopharyngeal angiofibroma

Acta Otolaryngol

(2016)

J.L. Sperry et al.

Western trauma association critical decisions in trauma: penetrating neck trauma

J Trauma Acute Care Surg

(2013)

S. Mallick et al.

Long-term treatment outcomes of juvenile nasopharyngeal angiofibroma treated with radiotherapy

A. Szymańska et al.

Extranasopharyngeal angiofibroma: clinical and radiological presentation

Eur Arch Otorhinolaryngol

(2013)

G.B. Singh et al.

A rare case of angiofibroma arising from inferior turbinate in a female

J Clin Diagn Res

(2016)

S. Ewe et al.

Nasal septal angiofibroma in a post-menopausal woman: a rare entity

J Clin Diagn Res

(2015)

M.M. Arruda et al.

Angioleiomyoma of the nasal cavity

Int Arch Otorhinolaryngol

(2014)

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Lobular capillary hemangioma (LCH) is a benign vascular lesion typically affecting the head and neck region, especially the nasal cavity. However, its occurrence in the nasal cavity of the pediatric population is rare, making its diagnosis and management crucial in such cases.
A 7-year-old female presented with left-sided nasal obstruction and recurrent epistaxis for 4 months. Examination revealed a dark purplish-red nasal mass, which bled easily upon probing. CT scans showed a soft tissue lesion with post-contrast enhancement. Histopathological examination confirmed lobular capillary hemangioma. The patient successfully underwent surgical excision without pre-operative embolization.
LCH affects both the skin and mucous membranes. Although its exact etiology remains debated, trauma is a leading risk factor for its development. Biopsy and radiological investigations confirm its diagnosis. Differentiating LCH from other vascular disorders with similar presentations is essential for a thorough understanding and better management. Endoscopic surgical excision combined with electrodesiccation is the treatment of choice.
Intranasal LCH in children is infrequent. An accurate diagnosis is essential for a comprehensive understanding. Surgical excision with electrodesiccation is the preferred treatment, but the role of pre-operative embolization is still under discussion.
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The mainstay treatment of LCH is endoscopic surgical excision. Several studies have advocated pre-operative embolization of lesions, specifically for large lesions [17,18]. In their retrospective study of 40 patients with nasal LCH, Puxeddu et al. used pre-operative angiography and embolization in 2 patients.
Lobular capillary hemangiomas are fast-growing benign vascular lesions with distinctive histopathological characteristics. The head and neck region is a common location for lobular capillary hemangiomas. However, the presence of such lesions in the nasal cavity is rare. Although several contributing factors have been identified in literature, the exact pathophysiology is not yet well understood. Predisposing factors include nasal trauma, pregnancy, and the use of contraceptive pills. Thus, the disease is more prevalent in females, with variable peak incidence in pediatric patients. Unilateral nasal obstruction and recurrent epistaxis are the most common symptoms of nasal lobular capillary hemangiomas. Radiological evaluation using contrast-enhanced computed tomography and magnetic resonance imaging is often required for large lesions.
We present a 30-year old female who presented to ENT clinics with two month complaint of left-sided nasal obstruction and epistaxis with left facial pain and headache. She had no predisposing risk factors. Imaging with CT and MRI revealed a large hypervascular mass in left nasal cavity. Surgical excision preceded by pre-operative embolization was done.
Endoscopic endonasal excision is the standard of treatment. While some authors believe that pre-operative embolization is not required, others advocate its use. Based on literature, recurrence rate is variable.
We believe that use of pre-operative embolization for large nasal lobular capillary hemangioma would have an impact on perioperative morbidity.
Severe epistaxis in pregnancy due to nasal pyogenic granuloma: A case report
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Pregnancy granuloma or granuloma gravidarum are among other terms for lobular capillary haemangioma occurring in pregnancy. It is the most common vascular lesion of the nasal cavity.6 In one of the largest case series investigating lobular capillary haemangioma, the lesion occurs more in women, with a ratio of 2:1, and at a mean age of 45 years.3
Mild to severe epistaxis is common in pregnancy and often results from increased vascularity of the nasal mucosa and hormonal changes. Symptoms may occur in the absence of an obvious local cause or any systemic disorder; however, thorough otolaryngological (i.e., “ENT”) evaluation is always warranted. Pyogenic granuloma or lobular capillary haemangioma is a benign fibrovascular proliferative tumour that is commonly found on the face, fingers, lips, and nasal mucosa. Pregnancy-induced pyogenic granuloma is not an uncommon entity and may result in torrential epistaxis if untreated. Managing a case of severe epistaxis during pregnancy usually requires multidisciplinary management. The authors present a case of severe epistaxis in pregnancy that necessitated examination of the nasal cavity under general anaesthesia. Intraoperative findings showed a bluish-red mass occupying the patient's right maxillary sinus. Bleeding was arrested and complete haemostasis was achieved. The nasal pyogenic granuloma completely resolved in the post-partum period.
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For treatment of intranasal LCH, endoscopic surgical excision with complete electrodesiccation of the tumor base is the treatment of choice [3]. Pre-operative vascular control in the form of embolization has been utilized in select cases and found to be useful [2,16]. On the other hand, others believe that surgery alone is the treatment of choice for LCH and that preoperative vascular control is unnecessary [17].
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In this case series, we present five cases of intranasal LCH. Three cases are of pregnant women that presented with epistaxis and nasal obstruction. The first was surgically treated during her pregnancy with preoperative embolization of the tumor for vascular control, while the other two patients were treated after delivery. The two other cases are of a post trauma pediatric patient, and an elderly lady with multiple co-morbidities, both presenting with recurrent nose bleeds and nasal obstruction. Surgical excision was performed with no complications observed post-operatively.
The etiology of LCH is unknown, but certain predisposing factors have been associated with the development of LCH and include pregnancy and trauma. The anterior portion of the nasal septal mucosa and the tip of the inferior turbinate are commonly involved sites. Computed tomography scans and histopathology are used to diagnose LCH. Treatment is surgical excision with or without pre-operative embolization.
LCH are rare tumors of the nasal cavity. Treatment of these lesions is surgical with or without preoperative vascular control.
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Case ReportLobular capillary hemangiomas: Case report and review of literature of vascular lesions of the nasal cavity

Abstract

Introduction

Section snippets

Case report 1

Case report 2

Vascular tumors of the nasal cavity

Conclusion

Conflict of interest

Eur Ann Otorhinolaryngol Head Neck Dis

Am J Otolaryngol

Eur J Surg Oncol

Am J Otolaryngol

Am J Otolaryngol

Eur Ann Otorhinolaryngol Head Neck Dis

Auris Nasus Larynx

Otolaryngol Clin N Am

Auris Nasus Larynx

Vascular tumours of the nasal septum

J Otolaryngol

Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes

Am J Surg Pathol

Lobular capillary haemangioma of the nasal cavity during pregnancy

J Laryngol Otol

Lobular capillary hemangioma formation: an unusual complication of submucous resection with power instrumentation of the inferior turbinate

Laryngoscope

Nasal lobular capillary hemangioma

J Clin Imaging Sci

CT features of lobular capillary hemangioma of the nasal cavity

AJNR Am J Neuroradiol

Sino-nasal hemangiopericytoma—a rare tumor

Med J Malays

Sino-nasal haemangiopericytoma

Indian J Otolaryngol Head Neck Surg

Nasal haemangiopericytoma: report of two cases with literature review

J Laryngol Otol

Combined therapy against recurrent and intracranial invasion of sinonasal hemangiopericytoma: a case report

Oncol Lett

Sinonasal-type hemangiopericytoma: a clinicopathologic and immunophenotypic analysis of 104 cases showing perivascular myoid differentiation

Am J Surg Pathol

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Acta Otolaryngol

Analysis of factors in successful nasal endoscopic resection of nasopharyngeal angiofibroma

Acta Otolaryngol

Western trauma association critical decisions in trauma: penetrating neck trauma

J Trauma Acute Care Surg

Long-term treatment outcomes of juvenile nasopharyngeal angiofibroma treated with radiotherapy

Extranasopharyngeal angiofibroma: clinical and radiological presentation

Eur Arch Otorhinolaryngol

A rare case of angiofibroma arising from inferior turbinate in a female

J Clin Diagn Res

Nasal septal angiofibroma in a post-menopausal woman: a rare entity

J Clin Diagn Res

Angioleiomyoma of the nasal cavity

Int Arch Otorhinolaryngol

Case Report
Lobular capillary hemangiomas: Case report and review of literature of vascular lesions of the nasal cavity