A rare case of pediatric intranasal lobular capillary hemangioma
Keywords:Pediatric nasal masses, Epistaxis, Embolization, Lobular capillary hemangioma, Pyogenic granuloma
Pediatric nasal cavity vascular tumors express a wide variety of pathologies. Lobular capillary hemangioma (LCH) is an acquired benign vascular growth of skin and mucosa whose etiology remains unknown, though trauma and hormonal influences are implicated. Although well documented in the head and neck literature for children age five or less, it is a rarity within the nasal cavity and has yet to be documented in the mid-septum. We describe a unique case of intranasal LCH and review the current literature. A nine-year-old male presented with one week of profuse intermittent unilateral epistaxis and no history of nasal trauma. Rhinoscopy revealed a pink, pedunculated mass of the right mid-nasal septum at the bony-cartilaginous junction. CT and MRI imaging were consistent with an expansile vascular lesion receiving prominent bilateral sphenopalatine artery supply. Following embolization, en bloc endoscopic surgical excision of the lesion using cold dissection was performed with no bony or cartilaginous involvement noted. The epistaxis resolved following resection. Final histology confirmed the mass as a lobular capillary hemangioma. Paediatric intranasal LCH is a rare entity, yet warrants consideration in our differential diagnosis of pediatric vascular tumors. Our study indicates these lesions can develop in the mid-septum despite the absence of a vascular plexus. Preoperative embolization should be considered for pediatric nasal cavity tumors due to concern for hemorrhage. Endoscopic wide local excision is an appropriate and effective treatment.
Rodriguez DP, Orscheln ES, Koch BL. Masses of the Nose, Nasal Cavity, and Nasopharynx in Children. Radiographics: a review publication of the Radiol Soc Nor Americ, Inc. 2017;37(6):1704-30.
Virbalas JM, Bent JP, Parikh SR. Pediatric nasal lobular capillary hemangioma. Cas Repor Medic. 2012;2012:769630.
Puxeddu R, Berlucchi M, Ledda GP, Parodo G, Farina D, Nicolai P. Lobular capillary hemangioma of the nasal cavity: A retrospective study on 40 patients. Americ J Rhinol. 2006;20(4):480-4.
Marino-Sanchez F, Lopez-Chacon M, Jou C, Haag O. Pediatric intranasal lobular capillary heman gioma: Report of two new cases and review of the literature. Respirat Medic Cas Report. 2016;18: 31-4.
Mills SE, Cooper PH, Fechner RE. Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes. Americ J Surgic Pathol. 1980;4(5):470-9.
Patrice SJ, Wiss K, Mulliken JB. Pyogenic granuloma (lobular capillary hemangioma): a clinicopathologic study of 178 cases. Pediatric dermatol. 1991;8(4):267-76.
Simo R, de Carpentier J, Rejali D, Gunawardena WJ. Paediatric pyogenic granuloma presenting as a unilateral nasal polyp. Rhinol. 1998;36(3):136-8.
Ogunleye AO, Nwaorgu OG. Pyogenic granuloma, a cause of congenital nasal mass: case report. Anna Tropic Paediat. 2000;20(2):137-9.
Kapella M, Panosetti E, Rombaux P, Delos M, Weynand B. Lobular capillary haemangioma of the nasal cavity: observation of three specific cases. Acta Oto Rhino Laryngolog Belgica. 2001;55(3): 241-6.
Karagama YG, Howarth K, Steel PR, Spencer MG. Lobular capillary haemangioma of the nasal vestibule: a rare entity. Int J Pediat Otorhinolaryngol. 2002;66(1):71-5.
Ozcan C, Apa DD, Gorur K. Pediatric lobular capillary hemangioma of the nasal cavity. European archives of oto-rhino-laryngology. J Europ Federat Hea Nec Surg. 2004;261(8):449-51.
Katori H, Tsukuda M. Lobular capillary hemangioma of the nasal cavity in child. Auris, nasus, laryn. 2005;32(2):185-8.
Benoit MM, Fink DS, Brigger MT, Keamy DG, Jr. Lobular capillary hemangioma of the nasal cavity in a five-year-old boy. Otolaryngol Hea Nec Surg. 2010;142(2):290-1.
Berlucchi M, Pedruzzi B, Farina D. Radiology quiz case 2. Lobular capillary hemangioma (LCH). Archiv Otolaryngol Hea Nec Surg. 2010;136(11): 1141-3.
Ifeacho SN, Caulfield HM. A rare cause of paediatric epistaxis: lobular capillary haemangioma of the nasal cavity. Brit Med J case reports. 2011;2011.
M. Vijaya FA, G. Umarani, A. Sultan, Lobular capillary hemangioma of, nasal septum - a rare presentation Ie.
Yildirim U, Karli R, Gun S. Pediatric Intranasal Lobular Capillary Hemangioma: A Rare Clinical Entity. Balk Medic J. 2017;34(6):586-7.
Tamaki A, Babajanian E, D'Anza B, Rodriguez K. Lobular capillary hemangiomas: Case report and review of literature of vascular lesions of the nasal cavity. Americ J Otolaryngol. 2017;38(3):363-6.