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Pyogenic granuloma of the epiglottis
International Journal of Pediatric Otorhinolaryngology Extra 8 (2013) 97–98
Contents lists available at SciVerse ScienceDirect
International Journal of Pediatric Otorhinolaryngology Extra journal homepage: www.elsevier.com/locate/ijporl
Case report
Pyogenic granuloma of the epiglottis James Attra *, Mehdi Sina-Khadiv 1, Aaron Lin 1 Department of Otolaryngology, Keck School of Medicine of the University of Southern California, General Hospital 4136, 1200 N. State, Los Angeles, CA 90031, United States
A R T I C L E I N F O
A B S T R A C T
Article history: Received 14 June 2013 Received in revised form 22 June 2013 Accepted 25 June 2013
The lobular capillary hemangioma, commonly known as pyogenic granuloma, is a common benign vascular lesion arising from both cutaneous and mucosal sites. The lesion is prevalent in the pediatric population, although airway involvement is rare. To date localization to a supraglottic subsite remains unreported in the literature. Here we describe a unique case of pyogenic granuloma arising from the epiglottis of a three year-old patient. Published by Elsevier Ireland Ltd.
Keywords: Airway Vascular malformation
1. Report of case A 3-year old male with no significant medical history was transferred from an outside institution following several episodes of hemoptysis beginning several weeks prior to admission. The patient’s family denied any respiratory symptoms, noisy breathing or feeding difficulties. Additionally, there was no history of easy bleeding or bruising, and no familial bleeding diathesis was endorsed. The patient had never been intubated or undergone manipulation of the airway in any fashion. On evaluation as an inpatient, the patient was found to be mildly anemic. Physical examination revealed a well-developed child without any noisy breathing. Flexible laryngoscopy demonstrated a friable exophytic mass centered on the tip of the epiglottis. Otherwise the supraglottic and glottic structures appeared normal, and the bilateral vocal folds were mobile. The airway was widely patent. The patient underwent excision of the lesion in the operating room using direct laryngoscopy. Bronchoscopic exam was normal, and photodocumentation was performed. Pathologic analysis of the surgical specimen was diagnostic for lobulated capillary hemangioma. The patient was discharged home the following day with resolution of symptoms. On outpatient follow-up 6 weeks later, the patient continues to do well without any respiratory complaints. Trans-nasal endoscopy in the clinic was performed
* Corresponding author. Tel.: +1 323 226 7315. E-mail addresses: [email protected] (J. Attra), [email protected] (M. Sina-Khadiv), [email protected] (A. Lin). 1 Tel.: +1 323 226 7315. 1871-4048/$ – see front matter . Published by Elsevier Ireland Ltd. http://dx.doi.org/10.1016/j.pedex.2013.06.002
with photodocumentation of a well-healed epiglottis with no evidence of residual disease (Figs. 1–4). 2. Discussion Lobulated capillary hemangioma (LCH), commonly known as pyogenic granuloma, is a benign vascular lesion prevalent in both the pediatric and adult population [1]. Although most LCHs in children are localized to the head and neck [2], to our knowledge an LCH arising from the epiglottis is rare. Previous reports have described lesions localized to the oral cavity, glottis and lower airway [3–8]. Differential diagnosis of such a lesion should be
Fig. 1. Endoscopic view of the lesion.
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J. Attra et al. / International Journal of Pediatric Otorhinolaryngology Extra 8 (2013) 97–98
Fig. 4. Endoscopic exam at 6 weeks’ follow-up. Fig. 2. After removal using cold steel instruments.
and our case demonstrates the capacity for development and safe excision of the lesion in an uncommon laryngeal subsite. References
Fig. 3. Histologic examination revealed vessel proliferation in a lobular pattern.
inclusive of infantile hemangioma, respiratory papilloma, mucous retention cyst, giant cell tumor, post-traumatic granuloma and sarcoma. The diagnosis of a vascular lesion such as LCH is consistent with the patient’s initial presentation of hemoptysis,
[1] S.E. Mills, P.H. Cooper, R.E. Fechner, 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. 4 (5) (1980) 470–479. [2] K.A. Pagliai, B.A. Cohen, Pyogenic granuloma in children, Pediatr. Dermatol. 21 (1) (2004) 10–13. [3] M.U. Akyol, E.G. Yalc¸iner, A.I. Dog˘an, Pyogenic granuloma (lobular capillary hemangioma) of the tongue, Int. J. Pediatr. Otorhinolaryngol. 58 (May (3)) (2001) 239–241. [4] V. Pino Rivero, C.G. Pantoja Herna´ndez, A. Gonza´lez Palomino, M.E. Mora Santos, G. Barrantes Celaya, M. Guerra Camacho, Lobular capillary hemangioma on the floor of the mouth (pyogenic granuloma). Report of a case and literature review, An. Otorrinolaringol. Ibero Am. 33 (6) (2006) 607–611. [5] M.S. das Chagas, R. Pinheiro, S. dos, M.E. Janini, L.C. Maia, Pyogenic granuloma: lobular capillary hemangioma in the upper lip of a 24-month-old child: case report, J. Dent. Child. (Chic) 76 (September–December (3)) (2009) 237–240. [6] D.L. Walner, N.P. Parker, O.S. Kim, R.M. Angeles, D.D. Stich, Lobular capillary hemangioma of the neonatal larynx, Arch. Otolaryngol. Head Neck Surg. 134 (March (3)) (2008) 272–277. [7] S. Irani, T. Brack, M. Pfaltz, E.W. Russi, Tracheal lobular capillary hemangioma: a rare cause of recurrent hemoptysis, Chest 123 (June (6)) (2003) 2148–2149. [8] M. Chawla, C. Stone, M.J. Simoff, Lobular capillary hemangioma of the trachea: the second case, J. Bronchology Interv. Pulmonol. 17 (July (3)) (2010) 238–240.
Contents lists available at SciVerse ScienceDirect
International Journal of Pediatric Otorhinolaryngology Extra journal homepage: www.elsevier.com/locate/ijporl
Case report
Pyogenic granuloma of the epiglottis James Attra *, Mehdi Sina-Khadiv 1, Aaron Lin 1 Department of Otolaryngology, Keck School of Medicine of the University of Southern California, General Hospital 4136, 1200 N. State, Los Angeles, CA 90031, United States
A R T I C L E I N F O
A B S T R A C T
Article history: Received 14 June 2013 Received in revised form 22 June 2013 Accepted 25 June 2013
The lobular capillary hemangioma, commonly known as pyogenic granuloma, is a common benign vascular lesion arising from both cutaneous and mucosal sites. The lesion is prevalent in the pediatric population, although airway involvement is rare. To date localization to a supraglottic subsite remains unreported in the literature. Here we describe a unique case of pyogenic granuloma arising from the epiglottis of a three year-old patient. Published by Elsevier Ireland Ltd.
Keywords: Airway Vascular malformation
1. Report of case A 3-year old male with no significant medical history was transferred from an outside institution following several episodes of hemoptysis beginning several weeks prior to admission. The patient’s family denied any respiratory symptoms, noisy breathing or feeding difficulties. Additionally, there was no history of easy bleeding or bruising, and no familial bleeding diathesis was endorsed. The patient had never been intubated or undergone manipulation of the airway in any fashion. On evaluation as an inpatient, the patient was found to be mildly anemic. Physical examination revealed a well-developed child without any noisy breathing. Flexible laryngoscopy demonstrated a friable exophytic mass centered on the tip of the epiglottis. Otherwise the supraglottic and glottic structures appeared normal, and the bilateral vocal folds were mobile. The airway was widely patent. The patient underwent excision of the lesion in the operating room using direct laryngoscopy. Bronchoscopic exam was normal, and photodocumentation was performed. Pathologic analysis of the surgical specimen was diagnostic for lobulated capillary hemangioma. The patient was discharged home the following day with resolution of symptoms. On outpatient follow-up 6 weeks later, the patient continues to do well without any respiratory complaints. Trans-nasal endoscopy in the clinic was performed
* Corresponding author. Tel.: +1 323 226 7315. E-mail addresses: [email protected] (J. Attra), [email protected] (M. Sina-Khadiv), [email protected] (A. Lin). 1 Tel.: +1 323 226 7315. 1871-4048/$ – see front matter . Published by Elsevier Ireland Ltd. http://dx.doi.org/10.1016/j.pedex.2013.06.002
with photodocumentation of a well-healed epiglottis with no evidence of residual disease (Figs. 1–4). 2. Discussion Lobulated capillary hemangioma (LCH), commonly known as pyogenic granuloma, is a benign vascular lesion prevalent in both the pediatric and adult population [1]. Although most LCHs in children are localized to the head and neck [2], to our knowledge an LCH arising from the epiglottis is rare. Previous reports have described lesions localized to the oral cavity, glottis and lower airway [3–8]. Differential diagnosis of such a lesion should be
Fig. 1. Endoscopic view of the lesion.
98
J. Attra et al. / International Journal of Pediatric Otorhinolaryngology Extra 8 (2013) 97–98
Fig. 4. Endoscopic exam at 6 weeks’ follow-up. Fig. 2. After removal using cold steel instruments.
and our case demonstrates the capacity for development and safe excision of the lesion in an uncommon laryngeal subsite. References
Fig. 3. Histologic examination revealed vessel proliferation in a lobular pattern.
inclusive of infantile hemangioma, respiratory papilloma, mucous retention cyst, giant cell tumor, post-traumatic granuloma and sarcoma. The diagnosis of a vascular lesion such as LCH is consistent with the patient’s initial presentation of hemoptysis,
[1] S.E. Mills, P.H. Cooper, R.E. Fechner, 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. 4 (5) (1980) 470–479. [2] K.A. Pagliai, B.A. Cohen, Pyogenic granuloma in children, Pediatr. Dermatol. 21 (1) (2004) 10–13. [3] M.U. Akyol, E.G. Yalc¸iner, A.I. Dog˘an, Pyogenic granuloma (lobular capillary hemangioma) of the tongue, Int. J. Pediatr. Otorhinolaryngol. 58 (May (3)) (2001) 239–241. [4] V. Pino Rivero, C.G. Pantoja Herna´ndez, A. Gonza´lez Palomino, M.E. Mora Santos, G. Barrantes Celaya, M. Guerra Camacho, Lobular capillary hemangioma on the floor of the mouth (pyogenic granuloma). Report of a case and literature review, An. Otorrinolaringol. Ibero Am. 33 (6) (2006) 607–611. [5] M.S. das Chagas, R. Pinheiro, S. dos, M.E. Janini, L.C. Maia, Pyogenic granuloma: lobular capillary hemangioma in the upper lip of a 24-month-old child: case report, J. Dent. Child. (Chic) 76 (September–December (3)) (2009) 237–240. [6] D.L. Walner, N.P. Parker, O.S. Kim, R.M. Angeles, D.D. Stich, Lobular capillary hemangioma of the neonatal larynx, Arch. Otolaryngol. Head Neck Surg. 134 (March (3)) (2008) 272–277. [7] S. Irani, T. Brack, M. Pfaltz, E.W. Russi, Tracheal lobular capillary hemangioma: a rare cause of recurrent hemoptysis, Chest 123 (June (6)) (2003) 2148–2149. [8] M. Chawla, C. Stone, M.J. Simoff, Lobular capillary hemangioma of the trachea: the second case, J. Bronchology Interv. Pulmonol. 17 (July (3)) (2010) 238–240.