鼻腔鼻窦化脓性肉芽肿：异物嵌顿后潜在38年潜伏期。

文献信息

中文摘要

背景： 分叶状毛细血管瘤（LCH），也称为化脓性肉芽肿（PG），是一种良性血管病变，通常与轻微创伤或刺激相关，主要发生于口腔，且多见于女性。其发生于鼻腔鼻窦，尤其是男性，较为罕见，与远期儿童期创伤的关联仍为推测性假说。临床上，需与其他血管性鼻腔鼻窦病变如血管纤维瘤、血管瘤变异型及恶性模拟病变相鉴别。
病例介绍： 本罕见病例报告描述了一例极不寻常的43岁男性炎性鼻腔肿块，表现为左侧鼻塞、流涕和嗅觉减退两个月。内镜评估及CT/MRI显示一个高度血管化的肿块附着于左侧中鼻甲。值得注意的是，患者有5岁时左侧鼻腔异物嵌顿史，当时取出且无即刻并发症。这提示初始创伤与38年潜伏期后病变表现之间可能存在关联。肿块通过内镜手术成功整块切除。
结论： 本病例突出了鼻腔鼻窦PG一种潜在但罕见的病因学关联，提出假设：既往黏膜创伤，如异物，可能促成数十年后血管病变的延迟形成，尤其是在男性患者和不寻常的鼻部部位。全面的诊断性检查，包括影像学和组织病理学，对于确认诊断和确保完整的手术管理至关重要。患者在一年的随访中保持无症状，未见复发。

英文摘要

BACKGROUND: Lobular capillary hemangioma (LCH), also known as pyogenic granuloma (PG), is a benign vascular lesion typically associated with minor trauma or irritation, predominantly occurring in the oral cavity and in females. Its sinonasal occurrence, particularly in males, is rare, and an association with remote childhood trauma remains a speculative hypothesis. Clinically, it must be differentiated from other vascular sinonasal lesions such as angiofibroma, hemangioma variants, and malignant mimics.
CASE PRESENTATION: This rare case report descripts a highly unusual case of an inflammatory nasal mass in a 43-year-old male who presented with left-sided nasal obstruction, rhinorrhea, and hyposmia for two months. Endoscopic evaluation and CT/MRI revealed a highly vascular mass attached to the left middle turbinate. Notably, the patient had a history of foreign body entrapment in the left nasal cavity at the age of 5, which was removed without immediate complications. This suggests a potential association between the initial trauma and the subsequent manifestation of the lesion after a 38-year latency period. The mass was successfully excised en bloc through endoscopic surgery.
CONCLUSION: This case highlights a potential, albeit rare, etiological association for sinonasal PG, raising the hypothesis that past mucosal trauma, such as a foreign body, may contribute to the delayed formation of vascular lesions decades later, particularly in a male patient at an unusual nasal site. A comprehensive diagnostic workup, including imaging and histopathology, is essential to confirm the diagnosis and ensure complete surgical management. The patient remained asymptomatic with no recurrence observed at one-year follow-up.