An eleven month old girl with a lesion on ear auricle

Abstract

Case An eleven month old girl was referred to our clinic from an outer center because of a mass on the left auricle The patient rsquo;s previous medical history was natural Her laboratory tests were within normal limits The family was not aware if any trauma occured to the ear The mother reported that the mass occured 10 days ago and growed rapidly and reached this size On physical examination a mass with dimensions of approximately 2 5 cmx 2 5 cm located posterior to the left auricle was found The half solid solitary and wide based mass had a bright red color and bleeding and ulcer foci were present on the surface Picture 1 Other system findings were normal The patient was taken to the operation room for the aim of extracting the mass Diagnosis: Pyogenic granuloma The mass was extracted together with a small amount of normal tissue to prevent recurrence under general anesthesia The extracted red colored mass with dimension of 2 5x2 5x1 2 cm was a half solid lesion without a capsule No stiches were placed on the region where the mass was extracted and the wound was left for secondary healing No complication was observed during and after the operation and the patient was discharged on the second day after surgery On histopathological examination it was observed that capillary vessels with various dimensions summed together in the granulation tissue in a lobular pattern The surrounding tissue was edemateous and included plenty of inflammatory cells With these findings a diagnosis of pyogenic granuloma was made histopathologically Picture 2 Discussion Pyogenic granuloma PG is also called lobular capillary hemangioma by some authors 1 It is a tumor like reactive lesion frequently located in the skin Its frequency is not known exactly 2 3 The term pyogenic granuloma was used by Hartzell 4 in 1904 for the first time Although it is observed frequently in the head and neck region and oral and nasal cavity it is found very rarely in the other regions No other case with a localization in the auricle has been found in the literature Pyogenic granuloma is thought to be a reactive lesion occuring as a response to small trauma local irritation and hormonal factors 3 5 In approximately 1 3 of the cases a history of trauma is present and the lesion rapidly grows reaching mostly 2 3 cm in a few weeks 75 of PG cases occuring in the oral cavity originate from the gingiva 6 It has been reported that PG can originate from the lower lip tongue palate nasal mucosa and nasal cavity and rarely from the outer earway in the head neck region 3 7 The mutual characteristic of all these areas is potential of exposure to frequent trauma Clinically these lesions are observed as pedinculated and wide based lesions containing red nodular granular or ulcerated areas 2 3 They may have a size ranging from a few milimeters to a few centimeters 3 Histopathologically they are composed of hyperplastic granulation tissue with marked capillary vessels in a loose connective tissue stroma Biopsy should be done in all lesions which are thought to be PG clinically for differential diagnosis with other tumors In addition easy bleeding of the lesion because of marked increase in vascularization and presence of cosmetic disorder are also indications for surgery 3 We also preferred surgical treatment in our case both for diagnosis and treatment No recurrence was observed in the patient in the follow up period of one year There are some points about our case which should be emphasized Although the family gave no history of trauma related to the baby we belive that the baby might have damaged her auricle with her fingers since the lesion reached this size in a short period of 10 days As we mentioned before we could not find a case of PG located in the auricle when we screened the literature in Turkish and in English though rare localizations of PG are present No case of PG with a localization in the auricle is present in the series of Giblin et al 8 including 408 subjects and in another series including 21 subjects from our country Ad shy;dress for Cor shy;res shy;pon shy;den shy;ce: Vefa Kınış MD Dicle University Medical Faculty Department of Otolaryngology Diyarbakır Turkey E mail: vefakinis@hotmail com Re shy;cei shy;ved: 09 07 2011 Ac shy;cep shy;ted: 01 02 2012 References 1 Akyol MU Yalçiner EG Doğan AL Pyogenic granuloma lobular capillary hemangioma of the tongue Int J Pediatr Otorhinolaryngol 2001;58:239 41 2 Ramirez K Bruce G Carpenter W Pyogenic granuloma: case report in a 9 year old girl General Dent 2002;50:280 1 3 Neville BW Damm BW Allen CM Bouquot JE Oral and maxillofacial pathology 2nd edition W B Philadelphia: Saunders co 2004:437 95 4 Hartzell MB Granuloma Pyogenicum J Cutan Dis Syph 1904:22:520 5 5 Damm DD Fantasia JE Elevated and ulcerated nodule of lip Pyogenic granuloma Gen Dent 2002;50:466 8 6 Bhaskar SN Jacoway JR Pyogenic granuloma clinical features incidence histology and result of treatment: report of 242 cases J Oral Surg 1966;24:391 8 7 Hsu CH Chen CH Wang CH Bilateral external auditory canal pyogenic granuloma Otolaryngol Head Neck Surg 2008;139:596 7 8 Giblin AV Clover AJ Athanassopoulos A Budny PG Pyogenic granuloma ndash;the quest for optimum treatment : audit of treatment of 408 cases J Plast ReconstrAesthet Surg 2007;60:1030 5 9 Yenidünya MO Gürel M Adına benzemeyen bir patoloji: piyojenik granülom Yeni Tıp Dergisi 2009;26:90 5

Keywords

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Kulak kepçesinde lezyon olan 11 aylık kız çocuk

Öz

11 aylık kız çocuğu, kliniğimize başka bir merkezden sol kulak kepçesinde kitle nedeniyle sevk edildi. Hastanın özgeçmişinde bir özellik yoktu. Laboratuvar testleri normal sınırlardaydı. Aile kulağa herhangi bir travma olup olmadığını fark etmemişti. Anne kulaktaki kitlenin 10 gün önce ortaya çıktığını ve hızla büyüyerek bu duruma ulaştığını belirtti. Fizik muayenede sol kulak kepçesi arkasına yerleşimli yaklaşık 2,5x2,5 cm çaplı kitle saptandı. Kitle parlak kırmızı renkli, üzerinde kanama ve ülsere odakları olan yarı sert, soliter ve geniş tabanlıydı (Resim 1). Diğer sistem bulguları normaldi. Hasta kitleyi çıkarmak amacıyla operasyona alındı.

Anahtar Kelimeler

• Kulak
• kepçesinde
• lezyon