Pyogenic Granuloma in the Sinonasal Cavity: A Potential 38-Year Latency Following Foreign Body Entrapment.

BACKGROUND: Lobular capillary hemangioma (LCH), also known as pyogenic granuloma (PG), is a benign vascular lesion typically associated with minor trauma or irritation, predominantly occurring in the oral cavity and in females. Its sinonasal occurrence, particularly in males, is rare, and an association with remote childhood trauma remains a speculative hypothesis. Clinically, it must be differentiated from other vascular sinonasal lesions such as angiofibroma, hemangioma variants, and malignant mimics.

CASE PRESENTATION: This rare case report descripts a highly unusual case of an inflammatory nasal mass in a 43-year-old male who presented with left-sided nasal obstruction, rhinorrhea, and hyposmia for two months. Endoscopic evaluation and CT/MRI revealed a highly vascular mass attached to the left middle turbinate. Notably, the patient had a history of foreign body entrapment in the left nasal cavity at the age of 5, which was removed without immediate complications. This suggests a potential association between the initial trauma and the subsequent manifestation of the lesion after a 38-year latency period. The mass was successfully excised en bloc through endoscopic surgery.

CONCLUSION: This case highlights a potential, albeit rare, etiological association for sinonasal PG, raising the hypothesis that past mucosal trauma, such as a foreign body, may contribute to the delayed formation of vascular lesions decades later, particularly in a male patient at an unusual nasal site. A comprehensive diagnostic workup, including imaging and histopathology, is essential to confirm the diagnosis and ensure complete surgical management. The patient remained asymptomatic with no recurrence observed at one-year follow-up.