Page 64 - Revista Portuguesa - SPORL - Vol 52 Nº3

Classically, a hemangioma is either absent or flat at birth CONCLUSION
and then undergoes a period of rapid growth to present LCH is a rare lesion in the nasal cavity that should be
as a mass at around six weeks of age. In our case, the considered in the differential diagnosis of nasal masses
8
infant presented at our hospital with 54-days-old (seven in children and should be also considered when they are
weeks and five days), and we know it was congenital congenital, although exceptionally rare.
because there was a history of difficulty breathing since
birth, progressively worsening with the growing of the
mass. Referências bibliográficas
[1] Puxeddu R, Berlucchi M, Ledda GP, Parodo G, Farina D, Nicolai
Newborns are generally obligate nasal breathers for the P. Lobular capillary hemangioma of the nasal cavity: a retrospective
first few months of life and so nasal obstruction in this study on 40 patients. Am J Rhinol 2006; 20:480-4.
group can present as an acute respiratory emergency [2] Gernon TJ, McHugh JB, Thorne MC. Pathology quiz case 2.
8
Diagnosis: Nasal lobular capillary hemangioma (pyogenic granuloma).
in some cases. Arch Otolaryngology Head Neck Surg. 2010 Sep; 136(9): 930, 932-3.
LCH can occur at any age and usually presents as a [3] Benoit MM, Fink DS, Brigger MT, Keamy DG Jr. Lobular capillary
papule or nodule that rapidly develops over a period of hemangioma of the nasal cavity in a five-year-old boy. Otolaryngol
Head Neck Surg. 2010 Feb;142(2):290-1
a few weeks and is prone to bleeding and ulceration.2 In [4] Katori H, Tsukuda M. Lobular capillary hemangioma of the nasal
the pediatric population, LCH has been reported more cavity in child. Auris Nasus Larynx. 2005 Jun;32(2):185-8. Epub 2005 Mar
commonly in boys than in girls. 9 23.
[5] Ozcan C, Apa DD, Görür K. Pediatric lobular capillary hemangioma
The mechanism for the development of LCH is still of the nasal cavity. Eur Arch Otorhinolaryngol. 2004 Sep;261(8):449-
obscure. Trauma, hormonal influences, viral oncogenes, 51. Epub 2003 Dec 3.
underlying microscopic arteriovenous malformations, [6] Simo R, de Carpentier J, Rejali D, Gunawardena WJ. Paediatric
pyogenic granuloma presenting as a unilateral nasal polyp. Rhinology.
and the production of angiogenic growth factors have 1998 Sep;36(3):136-8.
been postulated to play a role in the pathogenesis. 1 [7] Ogunleye AO, Nwaorgu OG. Pyogenic granuloma, a cause
The most common presenting symptoms of LCH of of congenital nasal mass: case report. Ann Trop Paediatr. 2000
Jun;20(2):137-9.
the nasal cavity include unilateral epistaxis and nasal [8] Wyatt M. Nasal obstruction in children. In: Browning G, Burton
obstruction. In our case, the only symptom was nasal M, Clarke R et al. Scott-Brown´s Otorhinolaryngology, Head and Neck
1
obstruction, progressively worsening since birth. The Surgery; Seventh edition. Hoddler Arnold; 2008: pp1070-77.
[9] Mills SE, Cooper PH, Fechner RE. Lobular capillary hemangioma:
differential diagnosis of congenital nasal masses includes the underlying lesion of pyogenic granuloma. A study of 73 cases from
meningo-/encephaloceles, gliomas, hamartomas, the oral and nasal mucous membranes. Am J Surg Pathol 1980;4:470-9.
chordomas and teratomas.
8
The majority of LCH are usually small and tend to be
localized in the anterior part of the septum or at the
vestibule, but large lesions have a predilection for the
lateral nasal wall and, in particular, for the inferior
turbinate, as in our case.
1
Magnetic resonance image is an essential imaging tool
in the clinical evaluation of such lesions, to exclude
intracranial connection or extension. It was important
6
in our case, to exclude other differential diagnosis of
congenital masses, such as meningo-/encephaloceles
and an eventual extension toward the skull base.
Definitive diagnosis and differentiation of LCH from
other hypervascularized lesions is only possible after
histological evaluation. It is characterized histologically
by circumscribed anastomosing networks of capillaries
arranged in one or more lobules in edematous and
fibroblastic stroma.
9
Diagnosis and definitive treatment of nasal LCH is
accomplished by surgical excision. Endoscopic excision
2
is the preferred technique to ensure localization of the
mucosal origin. As with other sites of LCH, application
3
of cautery at the base of the lesion is advocated in hopes
of decreasing recurrence.
2
The clinical course of LCH is usually benign following
local excision of the lesion, although severe bleeding can
occur and recurrences have been reported. Endoscopic
4
evaluation also allows excellent surveillance during
follow-up in clinic. 2

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