Case report of a bleeding nasal polyp during pregnancy.

From the Division of Otorhinolaryngology, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR.

Reprint requests: Prof. Andrew van Hasselt, Division of Otorhinolaryngology, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR. Phone: [phone]; fax: [phone]; e-mail: [e-mail]

Abstract

We report a case of a pregnant woman who had a pyogenic granuloma that had caused chronic epistaxis for 1 week's duration. The lesion was excised and the patient recovered fully.

Case report

A 25-year-old woman came to the ENT department during the 20th week of her pregnancy. She had a 1-week history of left-sided nosebleeds, and she noted that her left nostril was blocked.

Examination revealed a red, lobulated lesion that filled the left nostril (figure). Because of the history of bleeding and the fact that the lesion had rapidly increased in size, there was concern that it was a malignancy. The mass was excised while the patient was under a short period of general anesthesia. The lesion was based on a small pedicle attached to the nasal septum. Excision was straightforward. The patient reported immediate relief of her symptoms. Histology confirmed that the mass was a pyogenic granuloma. The woman's pregnancy proceeded uneventfully, and at 1-year followup, there was no evidence of recurrence.

Discussion

Although this type of lesion is often referred to as a granuloma gravidarum or a bleeding polypus of pregnancy, histologically this lesion is a pyogenic granuloma. Because it can grow rapidly and bleeds, it can be mistaken for a malignant lesion. Pyogenic granulomas appear to be hormone-dependent because those that are not excised resolve after pregnancy.

Pyogenic granulomas arise from a narrow base, usually on the nasal septum, and they are easily excised. Although they spontaneously regress after pregnancy, the worry of malignancy and the distress caused by the obstruction and epistaxis often dictates that excision is the optimal course of management.