Lobular Capillary Hemangiomas of the Sinonasal Tract: Findings in a Contemporary Series with Emphasis on Recurrence
Steven C Smith, Rajiv M Patel, David R Lucas, Jonathan B McHugh. University of Michigan, Ann Arbor, MI
Background: Lobular capillary hemangioma (LCH) was defined by Mills et al. in 1980, as a distinctive lesion and subset of vascular lesions of the oral and mucosal membranes generally diagnosed as "pyogenic granuloma" (PG) (1). These constituted a minority of vascular lesions in the head and neck, but included cases in the sinonasal mucosae, with recurrence after excision noted in as many as 10%. However, a contemporary series observed lack of recurrence of sinonasal LCHs (2). As our experience and case reports have observed difficulty in extirpation of these lesions, we performed a clinicopathologic institutional review of sinonasal LCH.
Design: With IRB approval, we performed a systematic search of our institution's case files and medical record system, reviewing and tabulating clinicopathologic, histologic, and follow-up parameters of nasal or sinus lesions diagnosed as LCH or PG between 1989 and 2009. Lesions meeting Mills et al. criteria were included. Statistical analyses included two sample tests, chi-square tests, and Kaplan-Meier Analysis.
Results: Of cases identified, 34 of 45 (76%) met criteria for LCH. Presenting symptoms included epistaxis (78%), obstruction (34%), and pain (3%). No sex predilection was observed (17/18; M/F), nor was any difference in distribution of ages by sex (p=0.97) or of sex by age group (pediatric, reproductive age, and >40 years, p=0.48), with a median age of 39 years. Pregnancy was associated with 5/34 (15%) cases, while antecedent trauma was reported in 4/34 (12%). Histologically, ulceration was identified in 23 of 34 (68%) and prominent mitotic activity (>10/10 HPF) in 3 of 34 (9%). Cellularity of lobules was low in 8/34, moderate in 22/34, and dense in 4/34. In terms of recurrence free survival over a median follow-up of 36 months, we observed recurrence after excision in 13 of 34 cases (38%), including cases of clinically treated, unbiopsied recurrence (7/34, 21%) and biopsy-documented recurrence (6/34, 18%).
Conclusions: Review of a contemporary series of LCH observed similar distributions of age and sex, presenting symptomatology, and association with pregnancy to prior studies. In contrast to the only recent series (2), recurrence in this cohort was more frequent, comparable to that originally reported. Our findings suggest sinonasal LCH demonstrates greater local tenacity than previously appreciated. Awareness of this may aid in avoiding misdiagnosis of these lesions as other vascular lesions such as angiofibroma and angiosarcoma.
1. Mills et al. Am J Surg Path 1980.
2. Puxeddu et al. Am J Rhin 2006.
Category: Head & Neck
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 172, Tuesday Afternoon