Pyogenic Granuloma Research Articles

Pyogenic granuloma and its relation to Human Papilloma virus

Pyogenic granuloma and its relation to Human Papilloma virus

Use of Albumin In Situ Hybridization to Diagnose Cutaneous Metastatic Hepatocellular Carcinoma With Poorly Differentiated Features: A Case Report and Review of the Literature.

Hepatocellular carcinoma (HCC) rarely metastasizes to the skin. When it occurs, it is often poorly differentiated making the diagnosis challenging. There exists a male predominance, and clinical presentation usually includes papules or nodules resembling pyogenic granulomas or dermal deposits. Histopathology shows malignant dermal cells. Hepatoid features including nests or cords of cells arranged in a trabecular or pseudoglandular pattern, sinusoidal formation, or the presence of bile exist in less than 50% of cases. Limitations exist with immunohistochemical staining, particularly in poorly differentiated neoplasms. Albumin in situ hybridization is more sensitive for detecting poorly differentiated HCC. Immunostaining in conjugation with albumin in situ hybridization enhances the detection of metastatic hepatocellular carcinoma. We report the case of a 74-year-old man with a history of HCC and a stable lung metastasis who presented with painful, growing bumps on his nose for 2 months. Examination revealed multiple, pink to white, shiny dermal-based papules with telangiectasias involving the right nasal tip and naris. Alpha-fetoprotein level was markedly elevated. Computed tomography showed expanding right lower lobe lung nodules. Histopathology of the cutaneous biopsy revealed features of a poorly differentiated basaloid carcinoma. Immunohistochemical staining was diffusely positive for glypican-3, focally positive for arginase-1, and negative for hepatocyte paraffin 1. Albumin in situ hybridization was diffusely positive, clinching the diagnosis of HCC. Metastatic HCC is a rare encounter for dermatopathologists. We aim to increase awareness of its occurrence in patients with advanced HCC and highlight the importance of clinical correlation when faced with poorly differentiated or unusual-looking basaloid neoplasms.

Nail changes in patients receiving systemic isotretinoin therapy

In this study, it was aimed to describe isotretinoin-induced nail changes and increase patients’ treatment compliance. A total of 200 patients diagnosed with acne vulgaris were included in the study. 100 of the patients were started systemic isotretinoin treatment and 100 control patients were receiving topical acne treatment. Age and gender of all of the participants, duration of treatment, total doses per month, and type of nail changes were recorded. Patients with persistent nail changes were followed at the 3rd and 6th months after treatment. A total of 34 patients had nail changes in the isotretinoin group. These changes included onychoschizia (55.9%), leukonychia (11.8%), onychorexis (8.8%), median nail dystrophy (5.9%), pyogenic granulomas (5.9%), chronic paronychia and granulation tissue (5.9%), onycholysis (2.9%) and Beau’s line (2.9%). The rate of nail changes in the isotretinoin group was significantly higher than in the topical treatment group (34% vs. 11%, p:0.001). Isotretinoin increases the risk of nail changes, primarily onychoschizia. The risk of developing nail changes is not associated with treatment duration but is associated with the total cumulative dose. Nail findings induced by isotretinoin are completely reversible.

Comparative Study of Pyogenic Granuloma Management with Conservative Sclerotherapy to Invasive Surgical Excision: A Randomized Clinical Trial

Introduction: Pyogenic granuloma is a common benign reactive mucocutaneous lesion. Various treatment options like excision, sclerotherapy, cryotherapy, laser is widely practiced. Objective: This study was conducted to determine and compare the effect of 3% sodium tetradecyl sulfate to surgical excision in the management of oral pyogenic granuloma. Methods: The prospective randomized controlled trial was conducted among two equal randomly allocated groups (48 each) of histologically confirmed cases. Group A was treated by surgical excision while group B was treated by 3% STDS. Both groups were evaluated weekly for a month for pain and healing and 1st, 3rd & 6th for recurrence. Results: Pain score is statistically significant on 1st and 2nd week follow up. No clinical and statistical difference observed in pain on 3rd and 4th week. Clinically significant recurrence was observed in group ‘A’ (4.1%) than group ‘B’ on 3 months but was statistically insignificant. 1 recurrence was observed in group ‘B’ on 6 months whereas, 3 were reported from group ‘A’ in the same duration. Healing on 1st and 2nd weeks were comparable and statistically significant in both groups however the results failed to show any significant difference on 3rd and 4th week. The demographics showed mean age 30.97±12.4 years with 60.42% of incidence in female and the commonest site being mandibular anterior teeth (25%). Conclusion: Although, surgical excision is commonly practiced, it is associated with higher recurrence, increased pain score & prolonged healing period. On contrary, sclerotherapy with 3% STDS proved to be safer, minimally invasive and more accepted by patients with minimum postoperative morbidity.

Botryomycoma of the Nasal Vestibule: A Case Report from the Commune VI Referral Health Center of the District of Bamako/Mali

Pyogenic granuloma or botryomycoma or lobular capillary hemangioma is a benign proliferation of capillaries, precisely skin and mucous membranes. This pathology is considered rare in terms of nasal cavities. But cases are increasingly related to literature. Thus, this study concerns a case sitting at the level of the nasal vestibule. He is an adult of 58 years and male sex, who came for consultation in the ENT department at the commune VI reference health center of the district of Bamako / Mali, presenting as a reason for consultation a right nasal obstruction. The interrogation revealed that the start dates back to about eight months and marked by a serous rhinorrhea and an associated homolateral epistaxis of headaches. No predisposing factor and no medico-surgical history has been found. The scanner allowed us to define the contours of the mass and to guide the therapeutic decision. The mass was completely removed surgically into endonasal without incidence. Histological examination of the surgical sample concluded that a lobular capillary hemangioma. The patient was followed for 2 years without recurrence or complications. Because of its rarity in our context, we recommend particular attention to ENT specialists to avoid confusion and allow more studies for more discussions in the literature.

Vascular Anomalies Review of the Head and Neck for Physicians in Training

A basic understanding of vascular anomalies will aid physicians-in-training as they seek to properly diagnose and determine interventions for these patient presentations. The aim of this review is to create a resource for physicians in training that encompasses the most important clinical aspects of vascular anomalies. Vascular anomalies of the head and neck are divided into two categories: vascular tumors and vascular malformations. This review will first describe vascular tumors followed by vascular malformations. This review discusses major pathology found in both categories of vascular anomaly. Vascular anomalies are frequently found in pediatric populations and can persist into adulthood, making it important for trainees to identify them on physical exam. This developing field seeks to improve form, function, and quality of life for patients with vascular anomalies and often requires a multidisciplinary approach (i.e., otolaryngology, dermatology, genetics, plastic surgery, interventional radiology). Various medical and surgical treatment options are available. A basic knowledge of these anomalies will allow for accurate, early diagnosis and appropriate intervention which can ultimately improve patient outcomes. Search Strategy and Selection Criteria: The MEDLINE/PubMed database was searched for primary research and reviews discussing various vascular anomalies which include infantile hemangioma, congenital hemangioma, pyogenic granuloma, tufted angioma, kaposiform hemangioendothelioma, capillary malformations, lymphatic malformations, venous malformations, and arteriovenous malformations. This search was conducted from 7/5/2023 to 3/21/2024.

Rare Encounter: A Study of Oral Cavity Kaposi Sarcoma in Two Cases

Abstract Introduction/Objective Kaposi Sarcoma (KS) of the oral cavity, is an unusual vascular endothelial neoplasm and is the most common malignancy affecting the skin and internal organs in patients with AIDS. The tumor is caused by Human herpesvirus 8 (HHV-8). It rarely metastasizes and can be treated and totally cured by treating the AIDS disease. The oral cavity may be the only/ first site of KS, and therefore, is important in the diagnosis. The lesions present as multiple red-purple macules that develop into plaques or nodules. The hallmark microscopic features are spindle cell proliferation and irregular small, vascular slits, which often run parallel to the epithelium, as well as extravasated RBCs, with hemosiderin deposition and hyaline globules in 50% of lesions. HHV-8 nuclear staining is positive in all cases, which is crucial to differentiate it from other conditions with positivity for spindled cell markers: CD34, CD31, ERG, and FVIII R. The tumor can also be positive for lymphatic-specific markers (D2-40, LYVE-1, VEGFR3, and PROX1) Methods/Case Report We reviewed retrospectively archived cases from our TUH oral pathology database with available H&E slides diagnosed for Kaposi sarcoma between 2013 – 2023. We retrieved two confirmed cases, and we reviewed the slides and clinical information. Results (if a Case Study enter NA) Data were colleceted and analysed. Conclusion Incorporating Kaposi sarcoma into the differential diagnosis of pigmented red-purple vascular lesions in the oral cavity is of paramount importance. Detection of Kaposi sarcoma in this region bears significant prognostic implications, often serving as an initial sign of Kaposi sarcoma and indicating HIV infection. Lesions typically localize on the palate and gingiva. Heightened awareness of this clinical entity is crucial for facilitating early detection and treatment with antiretroviral drugs. Furthermore, the differential diagnosis for lesions with similar clinical presentations encompasses a broad spectrum, including benign conditions such as pyogenic granuloma, hemangioma, bacillary angiomatosis, and even granulation issue, as well as malignant tumors like angiosarcoma. It is noteworthy that considering Kaposi sarcoma in this context prompts pathologists to prioritize ordering stains for HHV-8. This diagnostic approach is supported by the exceptional sensitivity and specificity of HHV-8 stains, which exhibit 99% sensitivity and 100% specificity for diagnosing Kaposi sarcoma, while consistently yielding negative results in all other entities within the differential diagnosis.

Surgical pearl: A simple, fast, and less hemorrhagic technique of ligation for treating pedunculated granuloma pyogenicum

Surgical pearl: A simple, fast, and less hemorrhagic technique of ligation for treating pedunculated granuloma pyogenicum

Pyogenic Granuloma in a Pediatric Patient: A Case Report

Pyogenic Granuloma in a Pediatric Patient: A Case Report

Intravenous pyogenic granuloma of the external jugular vein

AbstractIntravenous pyogenic granuloma (IVPG) represents a subset of lobular capillary haemangioma. The preoperative diagnosis is complex due to the absence of distinct features specific to a particular diagnosis in the clinical presentation. Physical examination findings closely mimic those of other soft tissue growths. Ultrasound should be the preferred modality for preoperative diagnostic imaging, as the lesion typically exhibits consistent ultrasound characteristics. This knowledge is imperative for an accurate and timely diagnosis. This case report presents a histologically confirmed IVPG localised in the right external jugular vein, which has been present for 2 years and is progressively enlarging.

Treatment of Pyogenic Granuloma in the Edentulous Mouth

Treatment of Pyogenic Granuloma in the Edentulous Mouth

Treatment of Pyogenic Granuloma with Periodontal Surgery

Treatment of Pyogenic Granuloma with Periodontal Surgery

Involvement of Sex Hormones and Their Receptors in the Pathogenesis of Classic Kaposi's Sarcoma in Xinjiang.

This study aims to examine the expression of androgen receptor (AR) and estrogen receptor (ER) in patients with classic Kaposi's sarcoma (CKS) in Xinjiang, as well as to assess the serum levels of sex hormones in these patients. The objective is to explore potential new directions and targets for diagnosing and treating CKS in Xinjiang. The case group comprised 35 patients diagnosed with CKS who presented at our hospital from 2014 to 2021. The control group consisted of 35 patients with pyogenic granuloma (PG) who visited the hospital during the same period, selected using propensity score matching (PSM). Immunohistochemistry was used to detect AR, human herpesvirus type 8 (HHV-8), and ER in paraffin-embedded tissue samples from patients diagnosed with CKS and PG. Additionally, enzyme-linked immunosorbent assay (ELISA) was used to quantitatively measure serum sex hormone levels in the 35 patients with CKS and 35 patients with PG. AR expression was relatively weak in both the CKS and PG groups, with the PG group exhibiting a slightly stronger expression than the CKS group. Conversely, the expression of ER was significantly higher in the CKS group compared to the PG group (p < 0.05). Additionally, serum testosterone (T) levels were elevated in the CKS group, while serum estradiol (E2) levels were higher in the PG group (p < 0.05). Sex hormones and their receptors are implicated in the pathogenesis of CKS in Xinjiang. The use of ER antagonists may represent a novel avenue for research and treatment of CKS.

Beyond the screw: Exploring the recurrence of oral lesions

The integration of skeletal anchorage systems has revolutionized orthodontics, especially with the advent of mini-screws known for their ease of use and minimal invasiveness. The mandibular buccal shelf area, with its ample high-quality bone and low failure rates, has become a preferred extra-alveolar anchorage site. However, complications involving adjacent soft tissues are common with orthodontic bone screw placement. This case report describes the recurrence of reactive oral lesions following placement of orthodontic bone screws in the buccal shelf area. During the course of orthodontic therapy, the patient developed exophytic growths twice, at the same site, on the lower right back buccal mucosa. Diode laser was used in both instances for excision of the lesion and the specimen was sent for histo-pathological analysis. The first lesion was diagnosed as inflammatory fibrous hyperplasia, while the recurrent lesion was identified as pyogenic granuloma. At 12-months follow-up, no new lesions were detected. This report highlights the influence of lesion development time on its clinical and histological presentation. It is postulated that leaving the bone screw in place after initial biopsy could have contributed to its recurrence. Complete excision is the preferred treatment. Treatment options, including laser therapy, are available for such lesions.

Traumatic Fibroma : A Case Report

Fibroma is a benign fibrous tissue growth that develops as reactive hyperplasia to trauma or local irritation. It is usually characterized by slow growing, painless, firm, nodular mass merging with the colour of surrounding tissue. It is mainly seen in the region of buccal mucosa, along the plane of occlusion of maxillary and mandibular teeth, tongue, gingiva and hard palate. On clinical examination it resembles pyogenic granuloma, peripheral giant cell granuloma.

Periorbital Intravenous Lobular Pyogenic Granulomas: A Case Report and Literature Review of This Peculiar Pathology.

Intravenous lobular pyogenic granuloma (ILPG) is a seldom-documented pathology in oculoplastic and orbital literature. This study aims to elucidate the clinical presentation and histopathologic findings surrounding periorbital ILPG through a case presentation and literature review. We describe a 42-year-old male with a palpable periorbital subcutaneous nodule that was subsequently diagnosed as ILPG on immunohistochemistry. A literature review was performed by searching articles in the PubMed/MEDLINE database using the keywords "periorbital intravenous lobular pyogenic granuloma," "periorbital intravenous pyogenic granuloma," or "periorbital intravenous capillary hemangioma." The literature review identified 6 patients presenting with similar subcutaneous nodules that were diagnosed as periorbital ILPGs. All patients, including the one in this study, were treated with local excision. Only 1 patient (1/7; 14.3%) noted pain while 5 experienced swelling or fluctuance (5/7; 71.4%). In patients with documented pathology reports, all ILPGs involved the angular vein (6/6; 100%). Of the 3 patients who had follow-ups at 2 to 7 years postexcision, none had recurrence. Histopathologic findings demonstrate an intravascular lobular tumor composed of capillaries with endothelial cells and pericytes. Marked reactivity to anti-Wilms tumor type 1 (WT-1) and anti-Smooth muscle actin was noted in the capillary structure. ILPG can be included on the differential for well-circumscribed, subcutaneous periocular masses. While the etiology of periorbital ILPG is unknown, most cases are managed with surgical excision, and recurrence appears to be uncommon. In sharing these cases and histopathologic underpinnings of periorbital ILPG, we endeavor to describe this peculiar pathology for oculoplastic and reconstructive surgeons.

Artificial Intelligence (Neural Network) in the Diagnosis of Benign Skin Tumors in Pediatric Patients

Relevance: ten years ago, artificial intelligence (AI), particularly neural networks (NN), as a diagnostic option in practice seemed a distant prospect. Today, the use of AI is becoming an increasingly popular and daily improving approach in all aspects of clinical and fundamental medicine. Purpose: design and learning of a NN to recognize four types of benign melanocytic skin tumors, integration into a mobile app to apply in practice. Material and methods: сlinical and dermatoscopic analysis of skin tumors was carried out in 600 children. In 65 cases the tumors were removed. Histological types were dermal nevus – 43% (n=28), complex nevus - 33.8% (n=22), pyogenic granuloma - 10.8% (n=7), Spitz-nevus - 6.2% (n=4), blue nevus - 3.1% (n=2), melanoma - 3.1% (n=2). Seven patients with pyogenic granulomas and two patients with melanoma were excluded. The test set included 56 dermatoscopic images. Due to the small number of images augmentation was performed. The database has been increased from 600 images to 1800. NN is written in the machine language Python. The machine learning framework was TensorFlow 2.0. The network architecture is based on the pre-trained model “EfficientNet B7”. This model uses the “supervised learning” paradigm. Each element of the sample had a class affiliation. Results: an accuracy of 83% was achieved after a period of learning on the test set. Mathematical metrics calculated in the Scikit-learn library. Sensitivity was 100% (blue nevus), 73% (complex nevus), 93% (dermal nevus), 75% (Spitz-nevus), and specificity were 98%; 94%; 82%; 98%, respectively. AI was integrated into the mobile app “KIDS NEVI”. Conclusion: AI as an auxiliary method for the skin tumors diagnosis in children and adolescents has demonstrated high potential and great opportunities. Dermatoscopic analysis of a skin tumor and a mobile app are able to provide “double control”, quick and correct clinical diagnosis and determination treatment tactics.

Pediatric Intranasal Lobular Capillary Hemangioma: A Scoping Review and Multimedia Case Presentation.

Systematic, scoping literature review and case presentation. The goal of this study is to review current literature on management trends and outcomes of pediatric intranasal lobular capillary hemangioma (ILCH). A 14-year-old male patient presented with a 15-month history of unilateral epistaxis, nasal congestion, and mouth breathing. Further workup revealed a pale nasal mass obstructing the right nasal cavity. The patient was successfully treated using a minimally invasive endoscopic endonasal approach for mass resection and nasal floor free mucosal graft for septal reconstruction. Independent queries of the PubMed Central, MEDLINE, and Bookshelf databases were performed; articles from 1990 to 2023 were abstracted. All studies that described pediatric ILCH using the Boolean method and relevant search term combinations, including "Intranasal," "Lobular capillary hemangioma," "Pyogenic granuloma," "Pediatric," "Outcome," and "Management," were collected for subsequent analysis. A total of 407 relevant unique articles were identified for analysis. Of these, 19 articles were deemed appropriate for inclusion in this literature review. Twenty-two pediatric ILCH cases were identified with a mean age at diagnosis of 10.5 years. The majority of cases occurred in males and presented with recurrent epistaxis and nasal obstruction. Most lesions originated from the anterior nasal septum and were resected using an endoscopic endonasal approach with no recurrence at last follow-up. Pediatric ILCH, a benign vascular neoplasm, often presents with unilateral nasal obstruction and severe, refractory epistaxis. This comprehensive review aims to highlight the importance of including this lesion in the differential diagnosis for unilateral nasal obstruction and epistaxis in young children.

Pyogenic Granuloma Diagnosis and Management: A Practical Review.

Pyogenic granuloma (PG), or lobular capillary hemangioma, poses a clinical challenge with its uncertain etiology and treatment options. Although the clinical features and prevalence of PGs are well established, definitive evidence-based treatments remain elusive. This practical review aims to illuminate the complexities of PG management by analyzing surgical interventions based on literature analysis. A PubMed/Medline search of "pyogenic granuloma" and "surgery" yielded 1171 studies. Inclusion criteria targeted intervention-associated PG complications over 5% and treatment modalities, excluding nonclinical studies and topics unrelated to plastic and reconstructive surgery. Screening involved Oxford level of evidence, patient data extraction, complications, intervention types, success rates, sessions, follow-ups, and treatments. Thirty-one studies met inclusion criteria. Most studies were retrospective (67.7%). Ten studies satisfied intervention-linked eruptions, primarily oculoplastic, whereas 21 investigated both surgical and nonsurgical treatment modalities. Across interventions, 3579 patients (age: 34.2-85.7 years) were involved. Postsurgical PG complications averaged 15.1% and were treated predominantly with surgical excision, achieving nearly complete resolution. Surgical and nonsurgical treatment studies included 1233 patients (age: 3-46.5 years), demonstrating a 68.2% average resolution after a single session, with surgical excision exhibiting the highest success rate (96.2%) and minimal complications. This practical review highlights the complexities of managing PG, emphasizing a spectrum of effective treatments and potential postoperative complications. Ophthalmologic procedures showed PG incidences of 9%-24.4%. Surgical excision proved highly effective, surpassing methods like lasers and injectables that exhibited varied success rates requiring multiple treatment sessions. Challenges included study diversity and varying evidence levels, warranting further comparative research for PG management strategies.

Prevalence and Clinico-pathologic Profile of Biopsied Gingival Lesions from 2 Thai Dental Schools.

Gingiva can be afflicted by several pathological entities apart from gingivitis and periodontitis. There have been limited number of studies on gingival lesions, especially from Thailand. Aim: To analyze the prevalence and distribution of biopsied gingival lesions from Chulalongkorn and Rangsit Dental Schools, Thailand. Biopsy records of the participating institutions from 1995 to 2020 were reviewed for gingival lesions. The demographic data, site of lesions and diagnoses were collected. Data were analyzed by descriptive statistics. From a total of 16,207 biopsies, 1,589 cases (10.2%) were diagnosed in the category of gingival lesions. The mean age ± SD of the patients was 42.3 ± 18.6 years with the highest prevalence being in the fourth decade of life (17.4%). A male-to-female ratio was 0.48:1. The most common location was the posterior mandible (27.4%). Regarding the type of gingival lesions, non-neoplastic lesions (88.5%) outnumbered neoplastic lesions (11.5%). The most common lesion was pyogenic granuloma, followed by irritation fibroma and peripheral ossifying fibroma. Among the neoplastic lesions, squamous cell carcinoma was the most prevalent lesion followed by papilloma and lymphoma. Gingival lesions mostly occur in the fourth decade of life and have a predilection for female patients. The majority of the lesions are located in the posterior mandible. Non-neoplastic lesion, especially the reactive subtype, is the most prevalent group and pyogenic granuloma is the most common gingival lesion. Data from this study represent biopsied gingival lesions from Thailand which may be different from those of other countries. Key words:Gingival lesions, prevalence, demographic, clinico-pathological correlation, gingival biopsy.