Pyogenic Granuloma of the Distal Trachea

Abstract

Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a common, acquired, non-neoplastic, vascular lesion that is often found on the skin and oral mucosa. The term "pyogenic granuloma" is a misnomer, as the lesion does not contain purulent material and is not a granuloma. Lesions have also been reported in the gastrointestinal tract and during pregnancy. PG is a smooth or lobulated, red lesion on a sessile or pedunculated base that varies in size from a few millimeters and rarely exceeds 2.5 cm. The etiology of PG remains unclear but they are thought to develop spontaneously or after local minor trauma where excess production of angiogenic growth factors have been implicated. Trachea PG lesion is rare and there is only 1 known report in the literature. Our case is unique, given the location of the lesion and our treatment using bronchoscopic cryosurgery.

Lobular capillary hemangioma of the tracheobronchial tree

“…[10,15] Local trauma can lead to the production of angiogenic vascular growth factors, such as vascular endothelial growth factor (VEGF) and decorin; transcription factors (pATF2 and pSTAT3) and signal transduction pathways (MAPK) are overexpressed or activated in LCH, but their exact roles remain unclear. [11,16] LCH is usually accompanied by inflammatory changes, suggesting that a serious imbalance in the site of injury causes granuloma formation. To emphasize these pathological features, the term LCH was recently coined.…”

“…[17] LCH lesions are very rare in the airway, with only 11 cases reported in the trachea and left main bronchus. [2–11] Table 1 summarizes all reported LCH cases, including the current one.…”

“…[8,15] Similar methods are used for tracheobronchial LCH. Three cases were treated with cryotherapy, [2,7,11] after which the lesions located in the distal trachea in 1 case were not recurrent after 3 months. [11] One case was treated with biopsy forceps for lesions located in the trachea, and no recurrence was found in 8 months.…”

“…Three cases were treated with cryotherapy, [2,7,11] after which the lesions located in the distal trachea in 1 case were not recurrent after 3 months. [11] One case was treated with biopsy forceps for lesions located in the trachea, and no recurrence was found in 8 months. [2] Another case was treated with surgery, [3] while 2 patients were treated with APC.…”

“…Although a few related cases have been reported, none was associated with the bronchus intermedius. [2–11] A case of isolated LCH in the bronchus intermedius was diagnosed with pathologic examination of forceps biopsied specimens. In this case, the patient has been followed up for more than 2 years, and the administered treatments are proved to be very effective.…”