lobular capillary hemangioma ( lch ) , also known as pyogenic granuloma , is a benign , rapidly growing , hypervascular lesion .
its usual locations are the skin and mucous membranes of the head and neck , the nasal cavity being a rare site of origin.1 
 2 its etiopathogenesis is not fully established , although an association with traumatic and hormonal factors has been identified .
these lesions tend to occur more frequently after nasal surgery or nasal packing and in women during pregnancy or taking oral contraceptive pills.3 
  here , we present the first reported case of a nasal lch following an endoscopic transsphenoidal resection of a gonadotrophin - producing pituitary adenoma , reflecting a possible but rare complication of this procedure .
the neurologic examination revealed a bitemporal hemianopsia and the laboratory studies , including endocrinological investigation were normal .
she was diagnosed with a pituitary cystic macroadenoma and underwent an endoscopic transsphenoidal removal of the lesion in our institution by a team of two neurosurgeons experienced in endoscopic procedures .
nasal packing was done bilaterally with merocel ( medtronic ) ( polyvinyl - alcohol sponge ) nasal tampon lubricated with antiseptic cream , maintained for 5 days and then removed uneventfully . the histopathologic review established the diagnosis of a gonadotropin ( luteinizing hormone and follicle - stimulating hormone)-producing adenoma .
one month after the surgery , the patient presented with a progressively growing right nasal mass ( fig
physical examination revealed a reddish , smooth - surfaced mass , filling the right nasal cavity .
the mass was mobile and appeared pedunculated with its base attached to the anterior portion of the nasal septum .
the polyp was removed surgically , under general anesthesia and using nasal forceps and electrical cautery .
her blood pressure was normal , hemoglobin levels were discretely low , and coagulation tests were normal .
the bleeding was controlled with the insertion of a nasal inflatable balloon catheter and cautery with silver nitrate .
nasal endoscopy was repeated after 1 week , 6 months , and 1 year , showing no signs of lesion recurrence .
grossly , it appears as a friable polypoid mass , which can present ulcerations on its surface . on histopathological examination
its typical pattern is characterized by multiple , varying - sized capillaries in a lobular arrangement , surrounded by a loose fibromyxoid stroma.4 the most common locations for these lesions are the skin and mucous membranes of head and neck , particularly the gingiva of the oral cavity , the nasal cavity being a rare site of origin.1 
 2 within the nasal cavity , these lesions have been described to arise more frequently from the anterior portion of the nasal septum ( little area ) or the anterior portion of the inferior turbinate.5 
 6 it can occur at all ages and affects both the sexes equally.2 
  it presents usually by unilateral recurrent epistaxis and nasal obstruction , though in some cases smell alterations can be involved.1 the lesion is usually identified on direct examination of the anterior nasal cavity.7 
  the exact etiopathogenesis of this lesion is unclear , although some predisposing factors have been implied , such as local trauma or hormonal influences .
regarding traumatic factors , the most commonly reported are nose picking and nasal packing , which are thought to trigger an inflammatory process in response to traumatic injury to the surface exposed.2 
 7 also , hormonal stimulation has also been implicated , with some cases reported in association to pregnancy and oral contraception.8 in this case , the lesion developed after an endoscopic transsphenoidal pituitary access , which induces traumatic injury to the nasal mucosa both through intraoperative manipulation and postoperative nasal packing .
the pituitary adenoma removed was gonadotrophin - producing which can also provide a favorable hormonal environment .
the differential diagnosis of an exophytic hypervascular mass in the nasal cavity presenting with intermittent episodes of epistaxis includes juvenile nasopharyngeal angiofibroma , which occurs typically in adolescent male patients , angiomatous polyp and rare malignant lesions , such as nasopharyngeal carcinoma or metastasis.1 
 7 
  imaging studies might be required in larger lesions which pose diagnostic difficulties and require an evaluation of extent and relation to adjacent structures.6 ct - scanning reveals an intensely enhancing mass and an iso- or hypoattenuating cap of variable thickness .
bony changes ( erosion or displacement ) are not uncommon.3 
  treatment consists of total surgical excision that can be achieved through direct visualization endoscopically without significant complications .
this technique might also be used in follow - up and early detection of recurrences , which are uncommon after complete excision.1 
 7 pregnancy - related lesions might regress spontaneously after delivery.8 

this clinical case combines two predisposing factors to the development of a nasal lch  hormonal influence ( gonadotrophin - producing pituitary adenoma ) and local traumatic injury ( surgery and postoperative nasal packing ) .
nasal lch is a rare but possible complication of endoscopic transsphenoidal resection of pituitary adenomas .
 
 background  lobular capillary hemangioma is a rare benign tumor , most frequently located in the head or neck region , the nasal cavity being uncommonly affected . 
 its etiopathogenesis is not fully established , although traumatic and hormonal factors have been implied . 
 
 case description  a 50-year - old female patient underwent an uneventful endoscopic transsphenoidal removal of a pituitary cystic macroadenoma at our institution . 
 nasal packing was used in postoperative hemostasis . 
 histopathology was compatible with a gonadotrophin - producing adenoma . 
 one month after the surgery , the patient presented with frequent episodes of epistaxis and a progressively growing nasal mass , which was removed endoscopically . 
 its pathological examination confirmed a lobular capillary hemangioma . 
 
 conclusions  the authors present a clinical case combining two possible predisposing factors to the development of a nasal lobular capillary hemangioma : local traumatic injury through surgery and postoperative nasal packing and hormonal influence . 
 this lesion is a rare complication of endoscopic transsphenoidal resections of pituitary adenomas . 
Introduction
Case Report
Discussion
Conclusions