Pediatric intranasal lobular capillary hemangioma: Report of two new cases and review of the literature

BACKGROUND: Lobular capillary hemangioma (LCH) is an acquired benign vascular tumor of unknown origin. It usually affects skin and mucous membranes of the oropharynx. It rarely involves the nasal cavity which most commonly manifests as epistaxis. To our knowledge, only fifteen pediatric intranasal LCH cases have been reported in the literature. None of these occurred in the inferior turbinate. We report two new pediatric cases of LCH, one of them on the inferior turbinate and the other one on the anterior nasal septum. Our principal aim was to highlight the importance of considering this lesion as a differential diagnosis for pediatric unilateral nasal obstruction and epistaxis. METHODS: Retrospective case series and review of current literature regarding the possible causes, diagnosis, and treatment of nasal LCH. DESCRIPTION OF CASES: Two adolescents presented with symptoms of unilateral nasal obstruction and epistaxis. Plain and contrast enhanced computed tomography revealed a well-defined intensely enhancing lesion in both cases. Patients underwent transnasal endoscopic excision and bipolar electrocautery at the base of the tumor for hemostasis. Histopathological examination confirmed the diagnosis of LCH. DISCUSSION: Current epidemiological and pathophysiological data suggests that the development of LCH may be associated to previous nasal trauma or endocrine disorders. LCH should be considered in the differential diagnosis of all pediatric endonasal masses associated with unilateral epistaxis and nasal obstruction. Endoscopic total excision with bipolar electrocautery for hemostasis is an appropriate treatment.