Management of Nasal Lobular Capillary Hemangioma with Sunitib

Abstract

Renal cell carcinoma (RCC) is the most common malignancy of the kidney and highly vascular neoplasia that is provided by the vascular endothelial growth factor (VEGF) pathway. 1 Approximately 30% of patients present with advanced or metastatic disease, and systemic therapies are the mainstay treatment strategy in these scenarios. The most effective first-line options are anti-VEGF, immune checkpoint inhibitors, and their combinations. Sunitinib, pazopanib, lenvatinib, cabozantinib, and axitinib have been tested as first-line treatment either as monotherapy or in combination with pembrolizumab or nivolumab. 2 Additionally, these drugs are actively used and have changed the current practice owing to better overall survival rates.Lobular capillary hemangioma (LCH) or pyogenic granuloma is a benign lesion resulting from the vascular proliferation of endothelial cells. It is characterized by limited capillary vessels acquiring a lobular structure. Similar to hemangiomas, positive angiogenesis regulators are present, and VEGF-A signaling is crucial to their development. 3 However, the etiology is unknown. 4 It has a female predominance. LCH generally affects the mucous membranes of the skin and oral cavity, and the nasal cavity can also be affected. Nasal cavity LCH mostly originates from the nasal septum, nasal vestibule, and inferior turbinate. Generally, the lesions range between 1 and 8 cm. Patients generally present with epistaxis, nasal obstructive symptoms, and rhinorrhea, and imaging and histopathological evaluation confirm the diagnosis. 5,6 Moreover, the main treatment of LCH is surgical resection, classical local excision, or endoscopic excisional surgery. For unresectable diseases, cryotherapy, laser ablation, intralesional or systemic corticosteroids, and interferon are recommended as alternative treatment methods. 7,8 The use of anti-VEGF agents could be effective due to the high VEGF expression of LCH. For example, bevacizumab is effective when used intralesionally. 9,10 The 117 117 117