Oral Pyogenic Granuloma Research Articles

Assessment of estrogen receptor marker and smooth muscle actin marker in oral pyogenic granuloma

Soft tissue enlargement of the oral cavity usually existent a diagnostic challenge because many group of pathologic activity can cause these lesions. An enlargement may display a variation of normal anatomic structure, cyst, inflammation, developmental anomalies and neoplasm. These lesions included a group of reactive hyperplasia which arises in response to recurring; chronic tissue injury that provokes vigorous or extreme tissue repair response .so pyogenic granuloma is one of the many common entities in charge of soft tissue enlargement. Objective: The current study aimed to detect the immunohistochemical expressions of ER and alpha smooth muscle actin (α-SMA) for lobular capillary hemangioma (pyogenic granuloma). Material and Methods: fifty cases of confirmed diagnostic pyogenic granuloma were subjected to immunohistochemically assessment by using ER marker and Smooth Muscle Actin marker. Result: The immunohistochemically finding appeared that all 50 cases were positive for SMA marker while only 14 cases were positive for ER marker. So there is no significant difference between ER marker in relation to clinical parameters (age, gender and location) and intensity.

Pyogenic Granuloma: A Literature Review and A Case Report

Pyogenic granuloma of the oral cavity is a common, non-neoplastic, vascular tumor. The etiology is not clear and it is suggested to be attributed to different factors. It might be caused by a reaction to a stimulus such as trauma, viruses such as HSV-1, hormonal changes, as well as other factors such as tooth eruption or medication. Clinically it appears as a painless tumor that tends to bleed easily, with red color and rarely may be accompanied by a periodontal abscess and bone loss. Biopsy is the most common tool used for the diagnosis. Its treatment is usually surgical excision and lately the use of lasers for its excision has emerged. Special care should be given to pregnant women where the treatment varies. The aim of this review is to present the background of oral pyogenic granuloma and the case report presents the situation, histological image and treatment of an adult woman patient.

Oralni piogeni granulom - prikaz slučaja i pregled literature

Uvod: Pyogenic granuloma is a common non neoplastic growth in the oral cavity which is hyperplastic in nature. Various theories of etiopathogenesis have been suggested for pyogenic granuloma. It is commonly thought to be a response to various local irritants like calculus, foreign body material etc. It is hemorrhagic and often bleeds on touch. It usually causes local interference. Excisional biopsy is considered the treatment of choice for pyogenic granuloma followed by removal of the local irritants in order to avoid recurrence. This article presents a case of oral pyogenic granuloma in a 54-year-old patient in the gingiva extending up to the palate with a review of literature. Materials and methods: A thorough case history and clinical examination was done. A provisional diagnosis of pyogenic granuloma was given. Excisional biopsy was performed and the lesion was sent for histopathological evaluation. Result: Histopathological examination of the lesion confirmed the clinical diagnosis of pyogenic granuloma. Conclusion: Pyogenic granuloma is non neoplastic in nature and hence a detailed knowledge of this lesion is required in order to identify it in its early stage and to manage it appropriately before it causes any hindrance in normal routine functions.

Oral pyogenic granuloma: Analysis of 137 cases that presented in a Nigerian tertiary health institution


 
 
 
 Background: Oral pyogenic granuloma is a common oral lesion among African population. It often presents as a painless, pedunculated, or sessile mass within the oral cavity. However, etiopathogenesis of oral pyogenic granuloma is still debatable. This article reviewed and identified the possible predisposing factors to the development of oral pyogenic granuloma amongst patients presenting at a sub urban tertiary health care facility.
 Methods: Information about 137 patients that presented with pyogenic granuloma from January 2009 to December 2019 were retrieved from the records department of Federal Medical Centre, Nguru. The data that were reviewed and analyzed included ages of patients, gender, anatomical site of lesions, treatment instituted as well as clinical and histopathologic features.
 Results: Patients ages ranged from 10 to 70 years (mean=41.02± 2.1 years), with the greatest degree of occurrence (29.19%) in the third decade of life. The male-to-female ratio was 1:1.7. The most frequently involved site was the gingiva. Other sites where pyogenic granuloma was located were the tongue, check mucosa, and palate. Oral pyogenic granulomas were more prevalent in the maxilla than in the mandible, with the labiobuccal gingiva of both jaws more commonly affected. The main complaint of the patients was painless swelling associated with occasional bleeding. More than half of the lesions had a pedunculated base, with surface ulceration in some cases. All lesions were surgically excised, although 8.03% of the cases existed as recurrent lesions.
 Conclusion: Although the clinicopathologic features of oral pyogenic granuloma in the study population were similar to those previously reported and their aetiology multifactorial, this study revealed that poor oral hygiene status of patients played a major role in their development.
 
 
 

Outcome of Surgical Excision for Managing the Oral Pyogenic Granuloma

Objective: To determine the outcome of surgical removal of oral pyogenic granuloma in terms of post-operative pain (POP), post-operative healing and post-operative infection.
 Materials and methods: This observational study was conducted at Oral and Maxillofacial Surgery department, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad, from October 2018 to March 2019. Patients of oral pyogenic granuloma, 18-45 years old and either of gender were included. Surgical process of oral pyogenic granuloma were done under local anesthetic by giving infiltration surrounding deep oral pyogenic granuloma by 2% Xylocaine along with adrenaline. Patients were followed for three weeks on weekly basis to access post-operative complications including post-operative healing. Data was collected via study proforma.
 Results: Total 37 patients took part in the study; their mean age was 47.86+7.61 years. On 1st week assessment all patients were noted with history of mild pain, moderate pain and severe pain (19, 10 and 8 cases respectively), while healing was achieved in 19 patients. On second week assessment 25 patients exhibited mild pain and 6 exhibited moderate pain and healing was achieved by 16 patients. On 3rd week assessment, only 09 patients exhibited mild pain and mostly were healed few cases showed minor infection.
 Conclusion: It was concluded that surgical removal is valuable procedure for the management of pyogenic granuloma of oral cavity with lower rates of post-operative infection and pain, and highest rates of post-operative healing.

Granuloma piógeno oral recurrente con pérdida ósea alveolar y movilidad dentaria: Reporte de un caso inusual

Oral pyogenic granuloma is a benign multifactorial lesion that appears as a highly vascular gingival enlargement. It can be located anywhere in the oral cavity, most often in the vestibular marginal gingiva. It occurs most frequently in adult women and male children. It does not usually compromise bone tissue or teeth; its safest treatment is surgical excision, with a high recurrence risk. This study aims to report the case of a 9-year-old female patient who underwent oral pyogenic granuloma excision in the maxilla. The following year, she presented a possible lesion recurrence with alveolar bone loss and the mobility of an adjacent tooth. A biopsy and thorough curettage were performed, confirming the diagnosis of oral pyogenic granuloma.

Biopsied non-dental plaque-induced gingival diseases in a Chinese population: a single-institute retrospective study

BackgroundWhile inflammatory diseases such as gingivitis and periodontitis induced by dental plaque biofilms constitute the majority of gingival lesions, gingiva can also be affected by a variety of diseases with aetiologies different from bacterial biofilms. The aim of this study was to retrospectively analyze the frequency and distribution of non-dental plaque-induced gingival diseases (NDPIGDs) in the Chinese population in a single institute.MethodsA total of 6859 samples of biopsied gingival diseases during the period 2000–2019 were obtained from the Department of Pathology, Peking University Hospital of Stomatology. Lesions were categorized by histopathological diagnosis, pathological characteristics and the new classification of gingival health and gingival diseases/conditions. Demographic information, such as gender, location, and age, were also analyzed.ResultsAmong 6859 biopsied NDPIGD samples, the five most frequent diagnoses included oral squamous cell carcinoma (OSCC, n = 2094), fibrous hyperplasia (n = 2026), pyogenic granuloma (n = 478), epithelial dysplasia (n = 477), and epithelial hyperplasia/hyperkeratosis (n = 436). All types could be grouped into nine categories according to their pathological characteristics. The most common biopsied NDPIGDs category was “hyperplastic lesions” (n = 2648, 38.61%), followed by “malignant neoplasms” (n = 2275, 33.17%). The most common diagnosis types in each category were fibrous hyperplasia and OSCC. Of all NDPIGDs, most lesions could be categorized into the new classification of gingival health and gingival diseases/conditions; only 7.07% did not fit the current classification system.ConclusionsThe present study is the first report on the frequency and distribution of biopsied NDPIGDs in a Chinese population. Unlike previous studies, the most prevalent categories were “hyperplastic lesions” and “malignant neoplasms”. The proportion of “malignant neoplasms” and “oral potentially malignant disorders” was remarkably higher than in previous researches. Nevertheless, the study provided epidemiological information on many NDPIGDs, which could be useful for future health policies as well as screening programs.

Gingival Tumor in Young Female Patient: A Case Report

Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury or hormonal factors. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manifesting as small, red erythematous papules on a pedunculated or sometimes sessile base, which is usually hemorrhagic. The surface ranges from pink to red to purple, depending on the age of the lesion Conservative surgical excision is usually curative but recurrence is not unusual. Lasers and cryotherapy may also be employed.

Oral Pyogenic granuloma: Retrospective Review of 49 Cases in a Tertiary Care Dental Institution of Odisha

Pyogenic granuloma (PG) also known as “Lobular capillary hemangioma,” appears as an overgrowth oftissue due to irritation, physical trauma, or hormonal changes in the oral cavity. this present study is on aseries of cases comprising of 49 cases of pyogenic granuloma is the first of its kind reported from EasternIndia. Even though patients usually do not report the hospital for pyogenic granuloma unless the lesionis large and incapacitating, such number in four years is not very less. Therefore it may be deduced thatpyogenic granuloma is not rare in this part of India.

Oral pyogenic granuloma: An 18-year retrospective clinicopathological and immunohistochemical study.

Pyogenic granuloma (PG) is a lesion characterized by the proliferation of blood vessels, commonly affecting the skin and the mouth. We aimed to compare clinical, microscopic, and immunohistochemical features of the two types of oral PG: lobular capillary hemangioma (LCH) and non-LCH (NLCH). Epidemiological and clinical data from 2000 to 2018 were collected from the archives of our institution, and histopathological sections of PG were reviewed. Immunohistochemical analyses (CD34, D2-40, SMA, mast cell, and Ki-67) were performed in 34 cases. Sixty-two LCH and 107 non-LCH samples were included. The mean (±SD) age of the patients was 38.59 ± 16.96 years; 55.62% were female; 39.64% of cases occurred in the gingiva, 44% of the nodules were pedunculated, and 13.02% of patients reported a history of trauma. NLCH was more prevalent among older patients than LCH. The most prevalent site of LCH was the lips, while NLCH occurred more in the gingiva (P < 0.05). Epithelial atrophy, microvessels, SMA-positive areas, and Ki-67-positive nuclei were more prevalent in LCH (P < 0.05). PG accounted for 2.25% of lesions archived in the pathology service and most cases were NLCH. LCH and NLCH exhibited clinicopathological differences in terms of age, site, epithelial atrophy, vascularization, and proliferation rate.

Sclerotherapy – A novel modality in the management of oral pyogenic granuloma

Pyogenic granuloma is a commonly occurring inflammatory hyperplasia involving the oral cavity. Surgical resection of the lesion is the mainstay treatment of pyogenic granuloma. However, intraoperative bleeding, postoperative infection, and recurrence chances are more with the surgical technique. Therefore, sclerotherapy has evolved as an effective alternative approach, which is simple, noninvasive, with minimal discomfort to the patient and having little recurrences and few complications. This case report is an attempt to highlight the usefulness of sclerotherapy procedure in the management of orogingival pyogenic granuloma, particularly involving the anterior esthetic zone of the oral cavity.

Diode Laser as Minimal Invasive Treatment Modality for Oral Pyogenic Granuloma in a Pediatric Patient: A Case Report

The pyogenic granuloma is a soft-tissue growth relatively common in oral cavity, which is considered as reactive rather than neoplastic in nature. The pyogenic granuloma may occur at any age, but its peak incidence occurs in the second decade of life. Lasers emerged as an alternative surgical tool for such soft tissue lesions. Till now, there was no case reported in the literature about using diode laser for pyogenic granuloma in the pediatric patient. This article presents a case report of an 11 year-old boy with pyogenic granuloma in the anterior hard palatal region in relation to marginal gingiva of central incisors. A GaAlAs diode laser with wavelength 808±10 nm was used to perform laser surgery with parameters settings such as: Pulse-power: 5 W; Pulse-Length: 26μs; Frequency 20 kHz, Average output: 5 W. The fiber tip of 400 μm in contact mode was used for conducting the laser beam in excising the lesion. The whole laser surgical procedure was performed successfully and was found advantageous in intra-operative and post-operative aspects with faster and good healing in follow up visits. The behavior and anxiety of the patient were assessed before, during, and after the laser surgery procedure using the Venhams’s anxiety scale. Hence, Laser was found as the conservative surgical tool for pyogenic granuloma for minimally invasive dentistry and helped in instilling a positive dental attitude and behavior in pediatric patient.

Comparison of pyogenic granuloma excision using scalpel, electrosurgery and diode laser

Oral pyogenic granulomas, a common clinical condition, occurring in all age groups, and is seen frequently in females around the second decade of their life. It occurs as a sessile or pedunculated growth varies in color from red to purple. It is frequently seen on the marginal gingiva especially in the maxillary arch. Anterior teeth are more frequently affected then posteriors. They are commonly seen on the facial aspect and usually do not show radiologic findings. The treatment is surgical excision which was usually done with scalpel blade. However, with recent technological advances, excision can be done using electrosurgery and diode lasers. In the present case report, excision of pyogenic granuloma is done using scalpel, electrosurgery and diode laser. Keywords: Soft tissue lasers, Diode laser, Electrosurgery, Scalpel, Pyogenic granuloma

Assessment of Pyogenic Granuloma of the Gingiva in Iraqi Patient

Pyogenic granuloma is smooth or lobulated mass that is usually pedunculated, while some lesion aresessile. Usually it enlarge until complete its size within weeks or months and rare does exceed 2.5 cmin size. Oral pyogenic granuloma, which in reality is the most common gingival tumor, shows a strikingpredilection for the gingival accounting for 75% of all cases. Material and Method: The data of this studywas collected from oral pathology lab at dentistry college/ University of Baghdad, all cases from 2014 to2018 were reviewed and the pyogenic granuloma cases were recorded after preparing a pathological reportfor each patients the clinical parameters regarding the age, sex, code, site, anatomical location of lesionwere recorded. Results: The total number of pyogenic granuloma cases were 119, 76 cases were pyogenicgranuloma of the gingiva. Number of female equal to 71 while number of males is 48. The highest number26 patients was recorded in association with 11- 20 years group and lowest was in 71- 80 years group(only2 patients).Maxilla is more affected by pyogenic granuloma (66%) than sites in mandibular arch (34%).Conclusion: The clinical, demographic and pathological features of oral pyogenic granuloma in the Iraqipopulation in this study were similar to those in studies of populations from other countries. The predilectionsite of pyogenic granuloma was the gingiva.

Hyperpigmentation of Skin (Melasma) with Solitary Oral Pyogenic Granuloma Lesion: A Case Report

The pyogenic granuloma is a relatively is an exaggerated tissue response to localised irritation or trauma.Histologically, pyogenic granuloma does not present as granuloma and is devoid of pus. It is filled with vascularchannels filled with inflammatory fluid, connective tissue with immature fibroblasts and inflammatory cellsscattered.It occurs most commonly in the gingiva and also lips, tongue and buccal mucosa are the othercommon sites. Melasma is a common skin condition hyperpigmentation of sun-exposed areas, especially onthe face which is usually light to dark brown, symmetrical and irregular in appearance. Although melasmacan affect all races and both sexes, it is more commonly seen in women of child-bearing age and in darkskinnedindividuals living in areas with intense ultraviolet (UV) radiation. Hyper pigmentation on exposedareas such as the face can be a source of cosmetic concern for patients, that can negatively impact qualityof life (QOL). The present case reports a localized inflammatory hyperplasia of the maxillary gingivalof a 38 year male patient who was suffering from melasma. Melasma is a disorder of hyperpigmentationwith psychological impacts affecting majorly the face. Excisional biopsy of the lesion revealed findingssuggestive of Pyogenic Granuloma. Excision of pyogenic granuloma may also predispose to recession ofinterdental soft tissue.

Pyogenic granuloma: Case series

Pyogenic granuloma (PG) is a prevalent inflammatory hyperplasia of skin and oral mucosa which is often caused by constant low-grade local irritation, traumatic injury or hormonal factors. In many cases, gingival irritation and inflammation due to poor oral hygiene are precipitating factors. Oral PG occurs predominantly on the gingiva, but it is also encountered on the lips, tongue, buccal mucosa and rarely on the hard palate. Case report: 4 patients reported to the Department of Oral Surgery, Army College of Dental Sciences, Secunderabad complaining of a swelling of gums in front and back tooth region in upper and lower arch for past 6 months. The treatment plan included surgical excision of the lesion using diode laser as well as scalpel.Results: All the Four patients reported no pain after the surgery. They were discharged with a prescription of chlorhexidine mouthwash and necessary post-operative instructions. No recurrence or scarring was observed in 6-12 months follow-up. Conclusion: Although diode laser is a secure and efficient technique for the treatment of intraoral PG, in order to minimize its recurrence, the lesion should be excised with a wider margin down to the periosteum or to the causing agent. Also due to its high recurrence rate, long-term follow-up is recommended.

A firm mass of the maxillary gingiva

A firm mass of the maxillary gingiva

ANGIOGENESIS AND COX2 IN PYOGENIC GRANULOMAS: AN IMMUNOHISTOCHEMICAL STUDY

Oral pyogenic granuloma (PG) is a frequent reactive lesion. Angiogenesis and inflammation are involved in its development, however, its etiopathogenesis is still not fully understood. Objective: The immunoexpression of CD34 and COX2, markers used in the study of angiogenesis and inflammation, respectively, was evaluated. Study Design: Forty-nine PG cases were selected and divided into 25 cases of lobular capillary hemangioma (LCH) and 24 cases of non-LCH. For the analysis of CD34, 5 hot spot areas were chosen, from which 2 fields were selected, in which the positive cells were counted and a mean was taken from these values. The evaluation of COX immunoexpression was by means of a semi-quantitative analysis in 5 selected fields. For all evaluations, significant values were considered with P < .05. Results: Regarding the expression of CD34, the highest angiogenic indices were attributed to the histologic subtype of LCH in lesions with less inflammatory infiltrate. Regarding the expression of COX2, there was a higher frequency of scores 1 and 2 in the cases of LCH and non-LCH. There was no positive correlation between angiogenesis and inflammation (P < .004). Conclusion: It is suggested that these 2 processes participate in the pathogenesis of PG, but not necessarily synergistically. Oral pyogenic granuloma (PG) is a frequent reactive lesion. Angiogenesis and inflammation are involved in its development, however, its etiopathogenesis is still not fully understood. Objective: The immunoexpression of CD34 and COX2, markers used in the study of angiogenesis and inflammation, respectively, was evaluated. Study Design: Forty-nine PG cases were selected and divided into 25 cases of lobular capillary hemangioma (LCH) and 24 cases of non-LCH. For the analysis of CD34, 5 hot spot areas were chosen, from which 2 fields were selected, in which the positive cells were counted and a mean was taken from these values. The evaluation of COX immunoexpression was by means of a semi-quantitative analysis in 5 selected fields. For all evaluations, significant values were considered with P < .05. Results: Regarding the expression of CD34, the highest angiogenic indices were attributed to the histologic subtype of LCH in lesions with less inflammatory infiltrate. Regarding the expression of COX2, there was a higher frequency of scores 1 and 2 in the cases of LCH and non-LCH. There was no positive correlation between angiogenesis and inflammation (P < .004). Conclusion: It is suggested that these 2 processes participate in the pathogenesis of PG, but not necessarily synergistically.

ORAL PYOGENIC GRANULOMAS SHOW MAPK/ERK SIGNALING PATHWAY ACTIVATION, WHICH OCCURS INDEPENDENTLY OF BRAF AND RAS MUTATION

Introduction: Pyogenic granuloma (PG) is a common nodular lesion with a prominent vascular component which may affect different sites. BRAF and RAS mutations were reported on a set of PGs of the skin. Objective: To evaluate the presence of BRAF and RAS mutations in PG. Study Design: The present study assessed the role of the MAPK/ERK pathway in oral PG pathogenesis. Mutations in hotspot regions of oncogenes components of the MAPK/ERK pathway were investigated by Sanger sequencing. The immunoexpression of phospho-ERK1/2 was assessed by immunohistochemistry. Results: Oral PGs showed no mutations in the sequenced regions of the genes BRAF, KRAS, HRAS, and NRAS. Our results also showed that activation of MAPK/ERK pathway demonstrated phospho-ERK1/2 immunohistochemical positivity. Conclusion: In conclusion, although oral PG shows MAPK/ERK pathway activation, the driven molecular event remains to be elucidated.

PYOGENIC GRANULOMA OF THE TONGUE COINFECTED WITH CYTOMEGALOVIRUS IN AN IMMUNOCOMPROMISED PATIENT: A CASE REPORT

Cytomegalovirus (CMV) is an opportunistic infection that can lead to organ rejection in transplant recipients. In the oral cavity, it usually appears as nonhealing ulcers. For an accurate diagnosis, tissue biopsy has to be performed, and the antiviral drug of choice is ganciclovir. A 9-year-old female patient with a history of heart transplant 3 months prior was receiving prednisone and tacrolimus. Clinical examination revealed a soft, nontender, pink, pedunculated, and ulcerated covered with pseudomembrane mass of the right lateral border of the tongue with a history of trauma during intubation 2 months prior. Excisional biopsy was performed, and anatomopathologic evaluation revealed pyogenic granuloma and CMV infection. The patient was admitted to the hospital for ganciclovir treatment. Prior to the transplant, the patient was CMV(−) and the donor was CMV(+). Although the most common oral CMV manifestation in immunosuppressed patients are nonhealing ulcers, we report the first literature case of oral pyogenic granuloma coinfected with CMV. Cytomegalovirus (CMV) is an opportunistic infection that can lead to organ rejection in transplant recipients. In the oral cavity, it usually appears as nonhealing ulcers. For an accurate diagnosis, tissue biopsy has to be performed, and the antiviral drug of choice is ganciclovir. A 9-year-old female patient with a history of heart transplant 3 months prior was receiving prednisone and tacrolimus. Clinical examination revealed a soft, nontender, pink, pedunculated, and ulcerated covered with pseudomembrane mass of the right lateral border of the tongue with a history of trauma during intubation 2 months prior. Excisional biopsy was performed, and anatomopathologic evaluation revealed pyogenic granuloma and CMV infection. The patient was admitted to the hospital for ganciclovir treatment. Prior to the transplant, the patient was CMV(−) and the donor was CMV(+). Although the most common oral CMV manifestation in immunosuppressed patients are nonhealing ulcers, we report the first literature case of oral pyogenic granuloma coinfected with CMV.