- 期刊
Nasal Septal Pyogenic Granuloma Extending to Nasopharynx-A Case Report and Literature Review
延伸至鼻咽部之鼻中隔化膿性肉芽腫－病例報告及文獻回顧
摘要
Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular lesion that grows rapidly on the skin or mucous membranes of the head and neck region. The oral cavity is the most common site for mucosal lesions, and the nasal septal pyogenic granuloma is a rare occurrence, presenting as a solitary red exophytic papule that bleeds easily. It is more common in the third decade of life with a female predominance. While its pathogenesis remains unknown, it is commonly associated with hormonal changes during pregnancy or oral contraceptive use, nasal trauma, and systemic or local infections. Recurrent epistaxis accompanied by nasal obstruction is the most common symptom of nasal septal pyogenic granuloma. Although there is no standardized treatment approach, surgical excision is the mainstay treatment. A 71-year-old male patient without known systemic disease presented to our emergency department for on-and-off right-sided epistaxis. Nasal packing with a Foley catheter balloon and Vaseline gauzes for 72 hours were used for hemostasis. After removal of the Foley catheter and Vaseline gauzes, nasopharyngoscopy revealed a bulging mass arising from the posterior end of the right nasal septum and extending into the nasopharynx. The mass was completely excised with endoscopy assistance under general anesthesia, and the wound bed was cauterized to achieve hemostasis. The pathology report disclosed pyogenic granuloma. Pyogenic granuloma rarely appears on the posterior nasal septum near the choana, and growths in this location can be mistaken for nasopharyngeal tumors. Additionally, the clinical symptoms of pyogenic granuloma may resemble those of nasopharyngeal carcinoma. Moreover, this patient lacked the typical risk factors associated with pyogenic granuloma, which further complicated the diagnostic process. Therefore, we present this case report to share the challenges we encountered in the diagnostic process while distinguishing it from nasopharyngeal cancer.
並列摘要
化膿性肉芽腫（pyogenic granuloma）又稱為小葉狀微血管瘤（lobular capillary hemangioma），是一種好發於皮膚或粘膜之良性血管病變。常發生於頭頸部，口腔是黏膜病變最常見的部位，而鼻中隔的化膿性肉芽腫則是罕見的。好發於20歲至30歲左右之女性。致病機轉尚不明，目前認為與賀爾蒙改變（如懷孕或使用口服避孕藥）、鼻部創傷以及全身性或局部感染有關。臨床表現通常為單一、生長快速、外觀紅腫且易反覆流血之腫塊。反覆流鼻血合併鼻塞是鼻部化膿性肉芽腫最常見之症狀。儘管缺乏標準化治療方法，手術切除是主要治療手段。此病例報告為1名71歲男性病患，過去病史無系統性疾病。因間歇性右側鼻出血至本院急診求治，經會診本科，使用Foley導尿管氣囊及凡士林紗條進行鼻填塞來加壓止血，於72小時後順利移除並出院。門診回診經鼻咽內視鏡檢查顯示右側鼻中隔後端約1cm之腫塊伴隨出血，並延伸至鼻咽部。後續安排在全身麻醉下結合內視鏡輔助，做右側鼻中膈腫塊切除手術併灼燒止血。病理報告證實為化膿性肉芽腫（pyogenic granuloma）。因化膿性肉芽腫罕見出現在鼻中隔後端近後鼻孔處，而此位置容易被誤認為鼻咽腫瘤。此外，化膿性肉芽腫的臨床症狀可能與鼻咽癌相似。此患者又沒有與化膿性肉芽腫相關的典型風險因子，使鑑別診斷過程更加複雜。因此提出病例報告及回顧相關文獻。