Sinonasal Lobular Capillary Hemangioma of the Nasal Cavity: A Rare Giant Vascular Tumor Managed With Preoperative Embolization and Medial Maxillectomy

TL;DR

A rare case of a large nasal blood vessel tumor was successfully treated with pre-surgery blood vessel blocking and nasal surgery.

Contribution

This case report highlights the successful management of a rare sinonasal lobular capillary hemangioma using preoperative embolization and medial maxillectomy.

Findings

Preoperative embolization significantly reduced intraoperative bleeding during surgery.

Complete excision via medial maxillectomy led to uneventful recovery.

Sinonasal LCH should be considered in the differential diagnosis of vascular nasal masses.

Abstract

Lobular capillary hemangioma (LCH), also known as pyogenic granuloma, is a benign vascular lesion most often found on the skin and oral mucosa. Its occurrence in the nasal cavity is uncommon, yet clinically significant because of its rapid growth, tendency to bleed, and similarity to more aggressive tumors. Although the exact cause is uncertain, trauma, hormonal influences, and vascular malformations have been suggested as contributing factors. We describe the case of a 41-year-old married woman with no known comorbidities who presented with progressive right-sided nasal obstruction, a gradually enlarging intranasal mass, recurrent episodes of epistaxis, and blood-stained thick nasal discharge for three months. On examination, a reddish, lobulated mass was seen filling the right nasal cavity and extending into the nasopharynx. The mass was tender and bled on touch. CT imaging showed a well-enhancing soft tissue lesion arising from the maxillary antrum with bony remodeling and erosion of the medial maxillary wall. Histopathology confirmed the diagnosis of LCH. The patient underwent medial maxillectomy via sublabial approach aided by endoscopic removal of the mass after preoperative embolization, which significantly reduced intraoperative bleeding. Recovery was uneventful. Though rare, sinonasal LCH should be considered when evaluating vascular nasal masses. Early diagnosis and complete excision remain the mainstay of management. In large or highly vascular lesions, preoperative embolization can be a valuable adjunct to improve surgical safety.

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