Lobular Capillary Hemangioma of the Nasal Valve Area Which ...

The New Journal of Medicine 2009;26: H. Kurtaran 120-121 et al.capillaries surrounded by an edematous fibromixoidstroma with overlying hyperplasic squamousepithelium was seen and reported as LCH (Figure 2).Follow-up four years postoperative was uneventful.Figure 2. Histologic examination revealed a capillaryhemangioma with a lobular arrangement of capillaries(HE,×40)DISCUSSIONLCH is an uncommon, benign lesion which bleedseasily by manipulations due to its high vascularity.Mills 3 has claimed that the term “pyogenicgranuloma” is incorrect for the disease because itis neither infectious nor granulomatous in nature.LCH usually grows rapidly and ulceration iscommon in the early period of its development.LCH is seen in both gender and almost in everyage, however, it is most common in females andin the 3 rd decade. Most important underlyingcauses for LCH are hormonal imbalance and anexcessive inflammatory response after localtrauma to skin and mucosal membranes 3 . Thehigher incidence of LCH in gravid patients, womanusing oral contraceptives and post menopausalwomen supports a hormonal etiology 1,2 . In thecourse of the pregnancy a direct correlation hasbeen observed between the growth rate of thetumor and the rise in the levels of estrogen andprogesterone.LCH is commonly seen in oral cavity, especially ongingiva and rarely in the nose. When it is seen inthe nasal cavity, LCH mostly locates on theanterior portion of nasal septum (Little’s area),less frequently on anterior side of inferiorturbinate 4,5 . In this case LCH was arising from thelateral nasal wall, in the nasal valve area of leftnasal cavity. To the best of our knowledge, forLCH this location has not been described so far inthe literature.In nasal LCH the leading symptoms are usuallyepistaxis and nasal obstruction. In this case therewas no complaint of nasal bleeding. The patient’snasal obstruction had been related to her pregnancyby her physician and this was the reason why thepatient applied for examination a little bit late.In differential diagnosis, intranasal foreign body,nasal polyp, sarcoidosis, Wegener’s granulomatosis,hemangioperiostoma, hemangiosarcoma, Kaposi’ssarcoma and lymphoma should be considered.Total excisional surgery is sufficient for treatment.Endoscopic intervention is important in diagnosisof the lesion before biopsy and to distinguish LCHfrom malignant tumors. Endoscopy is also helpfulto excise tumor totally. In this case, the tumorand anatomic structures around it were visualizedperfectly by nasal endoscopy and tumor wasexcised completely. Recurrence is extremely rareafter total excision and most of the LCH resolvemostly after delivery anyway.LCH should be considered in gravid patients,woman using oral contraceptives and postmenopausal women if they have complaints ofnasal obstruction and nasal bleeding.REFERENCES1. Wang PH, Chao HT, Lee WL, Yuan CC, Ng HT. Severe bleedingfrom a pregnancy tumor. J Reprod Med 1997;42: 359-62.2. Smulian JC, Rodis JF, Campbell WA, Grant-Kels JM, Vintzileos AM.Non-oral pyogenic granuloma in pregnancy pregnancy: a report of twocases. Obstet Gynecol 1994;84: 672-4.3. Sheen TS, Ko JY, Hsu YH. Pyogenic granuloma: An uncommoncomplication of nasal packing. Am J Rhinol 1997;11: 225-7.4. Mills SE, Cooper PH, Fechner RE. Lobular capillary haemangioma;the underlying lesion of pyogenic granuloma: a study of 73 cases from theoral and nasal membranes. Am J Surg Pathol 1980;4: 471-9.5. Lee HM, Lee SH, Hwang SJ. A giant pyogenic granuloma in the nasalcavity caused by nasal packing. Eur Arch Otorhinolaryngol 2002;259: 231-3.Correspondence:Hanifi KURTARAN M.D.Fatih University Faculty of Medicine, Betepe-Ankarae-mail:hanifikurtaran@yahoo.comArrival date : 02.01.2009Acceptance date : 29.01.2009121