Pyogenic granuloma gravidarum: a case in the nasal cavity and the use of MRI as a preoperative surgical aide

Abstract

Pyogenic granuloma gravidarum is a benign fibrovascular proliferative lesion usually involving the oral gingivae in pregnant patients. While it also occurs, although less frequently, on other oral sites such as lips, tongue and palate, it is relatively unusual to find it in the nasal cavity. Furthermore, lesions normally involute spontaneously after childbirth. For persistent lesions requiring surgical management, imaging has historically been limited to CT. This case is notable not only for its uncommon location but also for its recurrent nature, failure to regress post partum and the use of MRI in the preoperative planning.

Pyogenic Granuloma Gravidarum of the Nasal Cavity Causing Recurrent Epistaxis. A Case Report and Review of the Literature

“…Usually, pyogenic granuloma gravidarum affects the oral mucosa, especially the gingiva, while the nasal cavity is an unusual site of location with a reported incidence of 7%-10% (1). Most cases of nasal pyogenic granuloma occur on the nasal septum (76%) and the inferior turbinate (12%-20%) (9,16). In our case, the lesion was located on the anterior part of the nasal septum.…”

“…When it occurs in pregnant women, it is usually referred as pyogenic granuloma gravidarum or "pregnancy tumor". Although the exact etiology remains unclear, nasal cavity trauma and increased levels of estrogen and progesterone have been usually implicated in the development of pyogenic granuloma (16). Other risk factors that have been described in the literature include preexisting skin conditions, viral oncogenes, underlying microscopic arteriovenous malformations and angiogenic growth factor production (4,9).…”

“…Regarding hormonal factors, higher levels of estrogen and progesterone during pregnancy have been associated with the pathogenesis of pyogenic granuloma gravidarum. It is believed that elevated levels of estrogen and progesterone could stimulate endothelial proliferation within the oral and nasal mucosa in response to preexisting local trauma resulting in granulation tissue formation (4,14,16). Oral contraceptives have also been related to a higher incidence of pyogenic granuloma (4).…”

“…Oral contraceptives have also been related to a higher incidence of pyogenic granuloma (4). The exact molecular mechanism is not yet known, but it seems that higher levels of circulating hormones are more important than the number of progesterone and estrogen hormone receptors which has been found to be similar in tissue samples of pyogenic granuloma from non-pregnant women, pregnant women and men (16). Another theory that has been proposed suggests that progesterone and estrogen receptors are transiently expressed in an early phase of the development of these lesions (4,22).…”

Severe epistaxis in pregnancy due to nasal pyogenic granuloma: A case report

“…12 Hence, it has been suggested that excision is indicated only in cases that fail to involute. 8 Surgical excision is the preferred treatment for lobular capillary haemangioma of the nasal cavity. Other methods include electrocautery, laser therapy, and embolization.…”