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\title{Congenital Lobular Capillary Hemangioma of Nasalseptum in a 4 Year Old Child -A Case Report}
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             \author[1]{Jyoti Ranjan  Das}

             \author[2]{Ajay  Manickam}

             \affil[1]{  RG Kar Medical College}

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\date{\small \em Received: 13 April 2015 Accepted: 3 May 2015 Published: 15 May 2015}

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\begin{abstract}
        


Lobular capillary haemangioma is a benign, rapidly growing lesion of skin and mucus membrane. It usually involves gingiva, lips, tongue, and buccal mucosa. Nasal cavity is a rare location. Generally cases of haemangioma have been reported in children with epistaxis and nasal obstruction. We report a case of a 4yr old boy with congenital lobular capillary haemangioma of nose without epistaxis.

\end{abstract}


\keywords{LCH, nasal cavity, congenital, endoscopic approach.}

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\let\tabcellsep& 	 	 		 
\section[{I. Introduction}]{I. Introduction}\par
apillary haemangioma are hamartomas and most commonly arise in head and neck, affects 2.6\% of all live births. \hyperref[b0]{1} They are noted soon after birth as pink to red macular lesion that rapidly increase in size \hyperref[b0]{1} . The lesion becomes raised, popular or polypoidal \hyperref[b0]{1} .Then they enter a quiescent phase and subsequently regress with 70\% disappearing by the age of seven. \hyperref[b0]{1} Lobular capillary haemangioma is a benign, rapidly growing lesion with microscopically distinctive lobular structre that affects the skin and mucus membrane of oral cavity. \hyperref[b1]{2} Gingiva, lips, tongue, buccal mucosa have been reported to be common sites of involvement. It was first described as `botryomycosis` by Poncet and Dort in 1897. \hyperref[b2]{3} It is rarely located in the nasal cavity. The most common site in the nose is nasal septum  {\ref 4, 5.} it affectsmales more than females. \hyperref[b5]{6} Micro trauma and hormonal factors are the most common etiological factors. In a typical presentation, lobular capillary haemangiomaappears at endoscopy as a red to purple mass not larger than 1cm associated with epistaxis. However, in more rare instances the lesion reaches a considerable size filling the nasal cavity and leading to a complain of nasal obstruction.The treatment is nasal endoscopic surgery \hyperref[b6]{7} .\par
We present a case of a 4yr old boy with intranasal lobular capillary haemangioma since birth, with nasal obstruction but without any complaint of nasal bleeding. It is considered in differential diagnosis Author ? ? ? ? ¥ § ?: Department of ENT and Head Neck Surgery, RG Kar Medical College, Kolkata, INDIA. e-mails: jdbegins007@gmail.com, ajaymanickam87@gmail.com of childhood endonasal mass without bleeding like dermoid cyst, nasoalveolar cyst, nasolacrimal cyst, meningocele, encephalocele, glioma, chordoma etc. \hyperref[b0]{1}  
\section[{II. Case Report}]{II. Case Report}\par
A 4yr old boy came to the outpatient department of a tertiary care hospital with a swelling in left side nasal cavity. According to his mother it was there since birth and progressively increasing in size with age. Patient had only complaint of nasal obstruction. There was no history of epistaxis, nasal discharge, and disturbance of smell, headache, facial pain or change of voice. Local examination of Ear, Throat, Head \& neck was within normal limits. There were no enlarged neck glands or palpable neck nodes.\par
On anterior rhinoscopy, a non-tendergreyishwhite mass with smooth surface and soft consistency was seen in left side of nasal cavity. There was no nasal discharge or sinus tenderness.Diagnostic nasal endoscopy showed its attachment to the anteroinferior portion of septum partially obstructing the left nasal passage. Also there was mild DNS to right. (Figure  {\ref 1}) Endonasal endoscopic excision of the lesion was planned under general anaesthesia. The nasal mass was completely resected with a rim ofnormal septal mucoperiosteum and perichondrium under GA.There was no needfor any perioperative blood transfusion.The surgical specimen was sent for histopathological examination. (Figure \hyperref[fig_1]{3}) On gross examination, mass was whitish with smooth surface measuring 2x1.2 cm in size. On histopathological examination, section shows a lesion composed proliferating capillaries of various size lined by flattened endothelium lying in a fibrous stroma suggestive of lobular capillary haemangioma. There was no evidence of malignancy. (Figure \hyperref[fig_2]{4}) The patient has been followed up for a period of one year, and there is no recurrence of growth. 
\section[{III. Discussion}]{III. Discussion}\par
Capillary haemangioma are hamartoma, most commonly arise on head and neck affecting 2.6\% of all live births 1 . They are noted soon after birth as pink to red macular lesion that rapidly increase in size. \hyperref[b0]{1} the lesions becomeraised, popular or polypoidal, then enter a quiescent stage and subsequently regress with 70\% disappearing by the age of seven. \hyperref[b0]{1} LCH was first described by Poncet and Dor in the year of 1897where they referred these tumours as small vascular tumours in finger of four patients. \hyperref[b2]{3} the authors referred to this condition as human botryomycosis thinking that the lesions were secondary to fungal infection.\par
In 1904, Hanziell coined the term pyogenic granuloma to describe these lesions which he suggested to be granulation tissue arising in response to bacterial infection. \hyperref[b7]{8} In 1980 Mills et al propose the term lobular capillary haemangioma derived from its characteristic microscopic features. \hyperref[b8]{9} Aetiology of LCH remains unclear but trauma and hormonal influencesare considered to be the main factors. A retrospective study of 112 patients by Pagliai and Cohen shows a history of trauma in 5\% with clinically diagnosed asLCH. \hyperref[b9]{10} other possible aetiologiesare viral oncogenes, microscopic AV malformations and over production of angiogenic growth factors. \hyperref[b10]{11} There is a well-established relationship between LCH and pregnancy.LCH commonly occurs in women who are pregnant and those who use oral contraceptives. These signs regress after delivery indicating a role of hormone in the growth of LCH. \hyperref[b11]{12} Patients with LCH commonly present with nasal obstruction and epistaxis. In our case, patient only presented nasal obstruction. The differential diagnosis for nasal mass without any epistaxis will be meningocele, dermoid cyst, glioma, and polyp. These can be differentiated by CT scan and MRI.\par
Recommended treatment of LCH in nasal cavity is endoscopic guided local excision with cautery at the base of tumour for hemostasis. \hyperref[b9]{10} this technique is associated with lower rate of recurrence. 9, 10 
\section[{IV. Conclusion}]{IV. Conclusion}\par
LCH is a rare lesion when it occurs in a nasal cavity. The exact is unknown. It may not be always presented with epistaxis or red colour polypoidal mass. It can be considered as a differential diagnosis of intranasal mass causing obstruction but no bleeding.\begin{figure}[htbp]
\noindent\textbf{12}\includegraphics[]{image-2.png}
\caption{\label{fig_0}Figure 1 :Figure 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3}\includegraphics[]{image-3.png}
\caption{\label{fig_1}Figure 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4}\includegraphics[]{image-4.png}
\caption{\label{fig_2}Figure 4 :}\end{figure}
 		 		\backmatter  			  				\begin{bibitemlist}{1}
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