Nasal lobular capillary hemangioma

Management of Capillary Hemangioma of the Sphenoid Sinus

Background and objectives: Capillary hemangiomas are rare, benign vascular tumors that mainly affect the skin and soft tissue, with scarce appearance within the nasal cavities and paranasal sinuses. Materials and methods: We present a case report of capillary hemangioma of the sphenoid sinus and a review of the literature in the last ten years. Results: Clinical and endoscopic examination of the nose, radiologic assessment and particular histologic features contribute to the correct diagnosis of capillary hemangioma of the nose and paranasal sinuses. Conclusions: Transnasal endoscopic resection of capillary hemangioma located in the nose and paranasal sinuses is a valuable treatment method with good outcomes.

Nasal lobular capillary hemangioma: Report of a case managed by endoscopic excision and pre-operative angio-embolization

INTRODUCTION

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.

CASE PRESENTATION

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.

DISCUSSION

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.

CONCLUSION

We believe that use of pre-operative embolization for large nasal lobular capillary hemangioma would have an impact on perioperative morbidity.

Lobular Capillary Hemangioma of the Ethmoid Sinus: A Report of Two Cases

Soft-tissue tumors are rare in the paranasal region. Lobular capillary hemangioma (LCH) is a distinctive vascular lesion most commonly seen on the skin and oral mucosa in the fourth and fifth decades of life. Forasmuch as the nasal cavity and paranasal sinuses are rare locations for LCH, it is not well known by many ENT surgeons. Here we present two cases of LCH of the ethmoid sinus. These cases are being reported owing to their scarcity as per the literature published global.

Intranasal Lobular Capillary Hemangioma with Multiple Sites of Origin during Pregnancy: A Case Report and Literature Review

In the present case report, we describe a 33-year-old pregnant woman in the third trimester with a history of recurrent epistaxis leading to frequent visits to the emergency department. Each episode of epistaxis was managed by anterior nasal packing. During endoscopic examination, a left nasal mass was seen. She was admitted and managed conservatively until she delivered her baby without complication. After delivery, a CT scan was taken, which showed an enhancing mass in the middle and lower meatus of the nasal cavity with no bony erosions. For symptomatic relief and tissue diagnosis, endoscopic surgical removal was advised. An intraoperative examination revealed a red, smooth, and well-circumscribed mass occupying the left nasal cavity and originating from the medial surface of the inferior turbinate and the inferior surface of the posterior part of the middle turbinate. A complete en bloc resection of the mass was performed endoscopically. The mass was sent for histologic analysis, which confirmed the diagnosis of lobular capillary hemangioma. Eventually, upon follow-up at two weeks, one month, three months, and six months postsurgery, no evidence of recurrence was detected.

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

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.

Nasal Lobular Capillary Hemangioma as a Complication after an Endoscopic Transsphenoidal Gonadotrophin-Producing Pituitary Adenoma Resection

Background Lobular capillary hemangioma is a rare benign tumor, most frequently located in the head or neck region, the nasal cavity being uncommonly affected. Its etiopathogenesis is not fully established, although traumatic and hormonal factors have been implied.

Case Description A 50-year-old female patient underwent an uneventful endoscopic transsphenoidal removal of a pituitary cystic macroadenoma at our institution. Nasal packing was used in postoperative hemostasis. Histopathology was compatible with a gonadotrophin-producing adenoma. One month after the surgery, the patient presented with frequent episodes of epistaxis and a progressively growing nasal mass, which was removed endoscopically. Its pathological examination confirmed a lobular capillary hemangioma.

Conclusions The authors present a clinical case combining two possible predisposing factors to the development of a nasal lobular capillary hemangioma: local traumatic injury through surgery and postoperative nasal packing and hormonal influence. This lesion is a rare complication of endoscopic transsphenoidal resections of pituitary adenomas.

Demographics and etiologic factors of nasal pyogenic granuloma

BACKGROUND

Nasal pyogenic granuloma (lobular capillary hemangioma) is a rare benign tumor of unclear etiology. This study describes the clinical characteristics and possible etiologic factors in a series of patients with pyogenic granuloma.

METHODS

All adult patients with a histologic diagnosis of pyogenic granuloma of the nasal cavity were identified between January 2005 and May 2015. A total of 128 charts were reviewed retrospectively for age, gender, clinical presentation, location of lesion, and medical history.

RESULTS

Thirty-eight patients were identified including 13 (34%) men and 25 (66%) women with a mean age of 45 years (range, 18-80 years). The majority (92%) presented with epistaxis and 76% had the lesion located on the septum. All patients had the lesion surgically excised with final pathology confirming pyogenic granuloma. Out of 38 patients, 15 (40%) had a concurrent history of altered hormonal activity (due to hormone therapy, pregnancy, or tumor), and 7 (18%) had prior injury to the nasal cavity.

CONCLUSION

This study is 1 of the largest case series of nasal pyogenic granuloma to be reported. In this series, this disease process was seen in approximately twice as many women as compared to men. Our data further supports prior studies, suggesting that altered hormonal activity and nasal injury may increase the risk of developing nasal pyogenic granuloma.

Extensively Myxoid and Hyalinized Sinonasal Capillary Hemangiomas: A Clinicopathologic Study of 16 Cases of a Distinctive and Potentially Confusing Hemangioma Variant

Capillary hemangiomas, the most common vascular tumors of the sinonasal region, are benign endothelial neoplasms, typically growing in an easily recognized lobular pattern. Some sinonasal capillary hemangiomas may show atypical features, such as high cellularity or mitotic activity, and represent more challenging diagnoses. Over the past several years we have seen in consultation a number of examples of sinonasal capillary hemangiomas displaying very striking stromal myxoid change and hyalinization, features that have received scant attention in the past. Available slides from 16 sinonasal capillary hemangiomas previously coded as showing such changes were retrieved from our archives. Submitting diagnoses included "query angiofibroma, rule out malignancy" (N=4), "vascular polyp, rule out malignancy" (N=3), "query malignant vascular tumor" (N=4), "sinonasal hemangiopericytoma" (N=1), and "benign vascular tumor" (N=1). Available radiographic studies often showed worrisome features. Grossly, the tumors ranged from 1.1 to 6.0 cm and appeared as ulcerated, vascular-appearing polyps. Microscopically, the tumors showed striking stromal myxoid change and/or hyalinization, which largely obscured the underlying lobular capillary arrangement. Within this myxohyaline matrix, a florid capillary proliferation was present, frequently with nonatypical mitotic activity. In some instances a branching, "hemangiopericytoma-like" vascular pattern was present in areas. The overall cellularity was low to moderate, and endothelial atypia or hyperchromatism was absent. Ulceration and thrombosis were frequently present. Immunostains to CD31, CD34, and SMA highlighted areas of lobular growth pattern inapparent on the routinely stained slides. Four tested cases were negative for androgen receptors and β-catenin. Follow-up from 12 patients revealed no local recurrences or metastases. Awareness of that sinonasal capillary hemangioma may show these unusual stromal changes, and the use of ancillary immunohistochemistry to highlight its lobular growth pattern should allow its confident distinction from more aggressive endothelial tumors (eg, angiosarcoma) and from nonendothelial tumors, including nasopharyngeal angiofibroma, solitary fibrous tumor, and sinonasal hemangiopericytoma-like tumor.