Answer for BIR CoW 28 Nov 2021
Lobular capillary hemangioma
Findings
Evidence of well defined T1 hypointense, T2 hyperintense lesion noted in left nasal cavity with no diffusion restriction or blooming. The lesion is posteriorly limited by posterior wall of nasopharynx, medially displaces the nasal septum, laterally causes remodeling of medial wall of maxillary sinus, and anteriorly seen protuding through nares of nasal cavity. On contrast administration the lesion shows avid enhancement. - Features suggestive of lobular capillary hemangioma Key point for diagnosis of lobular capillary hemangioma: Hyperintensity on T2-weighted images, marked enhancement of tumor with a non-enhancing thin peripheral ring, and a washout time-intensity curve pattern are characteristic MR imaging features of nasal lobular capillary hemangiomas. Top differentials 1) Inverted papilloma MRI often demonstrates a distinctive appearance, referred to as convoluted cerebriform pattern, seen on both T2 and contrast-enhanced T1 weighted images. This represents alternating lines of high and low signal intensity, the appearance of which has been likened to, albeit loosely, cerebral cortical gyrations. This sign is seen in 50-100% of cases and is uncommon in other sinonasal tumors 2)Venous malformation Typically located in lateral nasal wall, with centrilobular and mild contrast enhancement with central filling in delayed images 3)Juvenile angiofibroma Occurs exclusively in adolescent males in posterior nasal cavity near sphenopalatine foramen 4) Hemangiopericytoma More likely within sinus and may contain bone and cartilage
Discussion
Lobular capillary hemangioma is a benign, rapidly growing lesion characterized by a lobular proliferation of capillaries and previously described by multiple names, including pyogenic granuloma, eruptive hemangioma, granulation tissue-type hemangioma, granuloma gravidarum, pregnancy tumor, granulopyogenicum, and benign hemangioendothelioma. The mechanism of development of nasal LCH is still unclear, but proposed etiologic factors have included trauma, hormonal imbalance, viral oncogenes, microscopic arteriovenous malformations, angiogenic growth factors, and cytogenetic abnormalities. Nasal LCH may develop at any age but is more frequent in the third and fourth decades and in females; symptoms are facial pain, hyposmia, and headache may occasionally occur as well. At nasal endoscopy, the lesion usually appears as a red to purple polypoid mass that easily bleeds
References:
1. Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma: a study of 73 cases from the oral and nasal mucous membranes. Am J Surg Pathol 1980;4:470–79 PubMedGoogle Scholar 2. Karagama YG, Howarth K, Steel PR, et al Lobular capillary haemangioma of the nasal vestibule: a rare entity. Int J Pediatr Otorhinolaryngol 2002;66:71–75 CrossRefPubMedGoogle Scholar
Findings
Evidence of well defined T1 hypointense, T2 hyperintense lesion noted in left nasal cavity with no diffusion restriction or blooming. The lesion is posteriorly limited by posterior wall of nasopharynx, medially displaces the nasal septum, laterally causes remodeling of medial wall of maxillary sinus, and anteriorly seen protuding through nares of nasal cavity. On contrast administration the lesion shows avid enhancement. - Features suggestive of lobular capillary hemangioma Key point for diagnosis of lobular capillary hemangioma: Hyperintensity on T2-weighted images, marked enhancement of tumor with a non-enhancing thin peripheral ring, and a washout time-intensity curve pattern are characteristic MR imaging features of nasal lobular capillary hemangiomas. Top differentials 1) Inverted papilloma MRI often demonstrates a distinctive appearance, referred to as convoluted cerebriform pattern, seen on both T2 and contrast-enhanced T1 weighted images. This represents alternating lines of high and low signal intensity, the appearance of which has been likened to, albeit loosely, cerebral cortical gyrations. This sign is seen in 50-100% of cases and is uncommon in other sinonasal tumors 2)Venous malformation Typically located in lateral nasal wall, with centrilobular and mild contrast enhancement with central filling in delayed images 3)Juvenile angiofibroma Occurs exclusively in adolescent males in posterior nasal cavity near sphenopalatine foramen 4) Hemangiopericytoma More likely within sinus and may contain bone and cartilage
Discussion
Lobular capillary hemangioma is a benign, rapidly growing lesion characterized by a lobular proliferation of capillaries and previously described by multiple names, including pyogenic granuloma, eruptive hemangioma, granulation tissue-type hemangioma, granuloma gravidarum, pregnancy tumor, granulopyogenicum, and benign hemangioendothelioma. The mechanism of development of nasal LCH is still unclear, but proposed etiologic factors have included trauma, hormonal imbalance, viral oncogenes, microscopic arteriovenous malformations, angiogenic growth factors, and cytogenetic abnormalities. Nasal LCH may develop at any age but is more frequent in the third and fourth decades and in females; symptoms are facial pain, hyposmia, and headache may occasionally occur as well. At nasal endoscopy, the lesion usually appears as a red to purple polypoid mass that easily bleeds
References:
1. Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma: a study of 73 cases from the oral and nasal mucous membranes. Am J Surg Pathol 1980;4:470–79 PubMedGoogle Scholar 2. Karagama YG, Howarth K, Steel PR, et al Lobular capillary haemangioma of the nasal vestibule: a rare entity. Int J Pediatr Otorhinolaryngol 2002;66:71–75 CrossRefPubMedGoogle Scholar
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!