Service ORL et chirurgie cervico-faciale, hôpital d'instruction des armées Laveran, Marseille cedex, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2012 Oct;129(5):278-80. doi: 10.1016/j.anorl.2011.10.005. Epub 2012 Aug 24.
Lobular capillary hemangioma is a frequent benign vascular inflammatory lesion of the skin tissue. It rarely reaches the mucous membrane, and the nasal fossa involvement is exceptional.
A 68-year-old woman presented with an ulcerous hemorrhagic mass blocking the left nasal fossa, which had appeared a few weeks after a wasp sting in the nose. The insect was evacuated only three weeks after the sting. The clinical and radiological data suggested malignancy. Biopsy under local anesthesia proved non-contributory and was complicated by 1 week's hospitalization for severe nosebleed. Surgical excision under video-endoscopy confirmed diagnosis. At 31 months' follow-up, the patient was free of recurrence.
DISCUSSION/CONCLUSION: The pathogeny of lobular capillary hemangioma is uncertain. No previous cases affecting the mucous membrane after insect sting have been reported. Except in the typical contexts of long-term packing or pregnancy, diagnosis can be difficult and misleading. It can mimic a malignant pathology. Its rich vascularization requires caution during biopsy, and the risk of recurrence requires excision to be complete.
小叶状毛细血管瘤是皮肤组织中一种常见的良性血管炎性病变。它很少累及黏膜,而累及鼻腔则更为罕见。
一位 68 岁女性因左侧鼻腔内溃疡性出血性肿块就诊,肿块在鼻部被黄蜂蜇伤后数周出现。昆虫在蜇伤后仅 3 周被清除。临床和影像学数据提示为恶性肿瘤。局部麻醉下的活检结果无明显意义,并因严重鼻出血住院治疗 1 周。在视频内镜下进行的手术切除证实了诊断。在 31 个月的随访中,患者无复发。
讨论/结论:小叶状毛细血管瘤的发病机制尚不清楚。尚无报道称昆虫蜇伤后会累及黏膜。除了在长期填塞或妊娠的典型情况下,诊断可能具有难度且具有误导性。它可能类似于恶性病理。其丰富的血管化需要在活检时谨慎操作,并且存在复发风险,需要完整切除。