Pyogenic Granuloma Research Articles

Pyogenic granuloma of eyelid: A literature review and case report

Pyogenic granuloma is an acquired vascular proliferative lesion with associated inflammation, affecting the skin and mucous membranes more frequently. Ocular pyogenic granulomas are rare, involving adnexa, conjunctiva, and cornea. Eyelid pyogenic granuloma is uncommon, associated with chalazion, lid surgeries, lacrimal sac procedures, trauma, predisposing cutaneous lesions, congenital capillary malformations, and idiopathic. We report a case of a 40-year-old male patient who attended our outpatient department with right eye upper lid painless growth, gradually increasing in size in the last two months. The differential diagnosis was burst chalazion, capillary haemangioma, molluscum contagiosum, pilomatricoma, basal cell carcinoma, squamous cell carcinoma, and Kaposi's sarcoma. The lesion was surgically excised, and histopathological examination confirmed the diagnosis. There was no recurrence. This present case illustrates the importance of considering benign inflammatory causes in the differential diagnosis of eyelid mass lesions to avoid unnecessarily aggressive intervention.

Diode laser excision of pyogenic granuloma

Pyogenic granuloma is a commonly occurring inflammatory hyperplasia of the skin and oral mucosa in females. It is a misnomer that is characterized histologically by angiomatous proliferation rather than a granulomatous lesion. This tumor-like growth is considered to be nonneoplastic in nature and has a varied clinical presentation. We present one such case of pyogenic granuloma, which was excised with a diode laser along with a relevant review of the literature.

Laser-assisted management of peripheral ossifying fibroma

Peripheral ossifying fibroma (POF) is the most common reactive gingival lesion. The cause and pathology are well understood. Peripheral giant cell granuloma, pyogenic granuloma, fibroma, and peripheral fibroma are among the differential diagnoses. The confirmed diagnosis for POF is based on histopathological evidence. A healthy 49-year-old man with fibrous swelling in the lower left anterior region of his jaw is discussed in this case report. Excisional biopsy was performed utilizing a diode laser in pulse mode at 980 nm. The patient was monitored for a year, and there was no recurrence.

Report of an esophageal pyogenic granuloma that grew rapidly in one year

Report of an esophageal pyogenic granuloma that grew rapidly in one year

Rapid Involution of Presumed Pyogenic Granuloma with Topical Timolol

Four months before presentation, a 27-year-old man had eyelid laceration repair after trauma to his right eyelids. He went to the emergency department (ED) with an enlarging and increasingly painful eyelid mass in addition to purulent discharge. He initially noticed the mass after surgery and experienced pain and subjectively blurry vision after surgery. He confirmed that the mass would bleed on occasion. Upon evaluation in the ED, visual acuity was 20/25 at near vision, and the mass was in contact with the cornea, 1 cm in size, firm, mobile, and attached firmly by a stalk to the palpebral conjunctiva (Fig A, lid everted).

Dermoscopic Analysis of Vascular Malformations and Tumors Based Upon Dominant Vascular Dermoscopic Features: A Retrospective Analysis From a Tertiary Care Center of East India.

BackgroundCutaneous vascular malformations and tumors comprise a vast group of conditions with variable clinical presentations. It is imperative to differentiate them from nonvascular lesions and from each other as their management and prognosis differ significantly. There is only sparse literature on dermoscopic features of various vascular malformations and tumors, especially from India.AimWe aimed to retrospectively study the dermoscopic findings of various vascular malformations and tumors based on their dominant vascular dermoscopic feature.MethodAll the vascular malformations and tumors for which clinical details and clinical and dermoscopic images were available were included in the analysis. The dominant vascular feature(s) was defined as a single or combination of two or more vascular features (in case a single vascular feature does not satisfy the criteria) that constitute more than 75% of the lesions’ vascular features. These included red, purple, blue, black (or any combination) dots, globules, lacunae, structureless area, linear, linear irregular, hairpin, comma, and arborizing vessels.ResultsA total of 52 patients with 68 vascular lesions (22 vascular malformations and 46 vascular tumors) were analyzed. Port-wine stain showed linear irregular vessels with sharp border with or without intervening white structureless area; unilateral nevoid telangiectasia had red dots and globules; angiokeratoma displayed red, reddish-purple to brown lacunae; blue color was seen in venous and glomuvenous malformation and venous lake; a mixed pattern was noted in infantile hemangioma and verrucous hemangioma; a red to reddish-white structureless area was observed in pyogenic granuloma and cherry angioma, and a subungual ill-defined pink structureless area was spotted in subungual glomus tumor.ConclusionThe dermoscopic features observed in various vascular lesions may overlap; however, the dominant dermoscopic feature along with its color may point to the diagnosis.

Polidocanol: A Review of Off-Label Dermatologic Uses.

Polidocanol is an FDA-approved treatment of incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein system, but numerous other off-label dermatological applications have been reported. To describe the various off-label dermatological clinical uses of polidocanol, as well as efficacy and adverse effects. The review of studies searchable on PubMed from 2004 to 2021 describing clinical uses of polidocanol to determine efficacy and adverse effects associated with various dermatologic applications. Polidocanol has shown efficacy in the treatment of mucocele of minor salivary gland, hemangioma, upper extremity veins, reticular veins of the chest, facial veins, pyogenic granuloma, lymphangioma circumscriptum, digital mucous cyst, mixed skin ulcers, cutaneous focal mucinosis, seromas, glomuvenous malformations, acne cysts, lymphocele, and dissecting cellulitis. Commonly reported side effects include pain, erythema, swelling, ecchymosis, and ulceration. Most sources were case reports and small prospective studies, as such the strength of data supporting many uses is limited by small sample sizes and lack of controls. Although polidocanol is currently only FDA approved for incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein system, the use of polidocanol has been selected for a variety of off-label clinical applications.

Clinicopathological analysis of 80 cases of oral lobular and non lobular capillary hemangioma (pyogenic granuloma): A Retrospective study

Background: Oral pyogenic granuloma (PG) is a clinicopathological entity that could develop due to the reaction to a variety of stimuli, such as low-grade local irritation, traumatic damage, and hormonal stimulation. There are two histopathological types of pyogenic granuloma; lobular type -capillary hemangioma (LCH) and non-lobular type; with PG,LCH has highly vascular, diffuse capillary growth while non- lobular variant mimicking granulation tissue with heavily inflammated stroma. The study aims were to review the clinical and histopathological spectrum of an oral pyogenic granuloma from different intraoral sites in order to avoid diagnostic pitfalls associated with similar morphological lesions and to determine whether lobular and non-lobular histopathological subtypes being distinct entities.
 Materials and Methods: A retrospective review of eighty formalin-fixed paraffin-embedded tissue blocks (40 cases each of males and females) were retrieved from the archives of Oral & Maxillofacial Pathology at the University of Baghdad, from 1979 to 2017. According to Mills et al., criteria for lobular capillary hemangioma description, the diagnosis of each case was confirmed by the examination of Hematoxylin and Eosin stained sections by an expert pathologists.
 Results:The present result revealed that patients with oral pyogenic granuloma were with age range from 12 to 59 years, with a mean of 30.57 years. Fourty nine cases (61.25%) out of eighty were of lobular pattern and 31 cases (38.7%) of non-lobular pattern type PG. The most common site of LCH was in the buccal mucosa, 12 cases (75%), while higher case numbers were observed in the 21-30 year age group. There were non-significant differences between lobular and non-lobular pattern prevalence regarding age groups and between other studied variables.
 Conclusio: It has been proposed that LCH and non-LCH subtypes reflect distinct phases in the development of a single lesion, which exhibits variable degrees of proliferative, angiogenic, and inflammatory activities.

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 in a Thalassemia Minor Patient: Consequence or Coincidence?

Thalassemia is a blood disorder inherited as an autosomal single gene characterized by a reduced or absent amount of hemoglobin chains. It is considered to be the most common genetic disorder with defect in either alpha or beta chains which produce abnormal blood cells. The present report describes an inflammatory enlargement over gingiva in the region of an erupting maxillary right premolar in a 10-year-old male who had minor thalassemia. The case was surgically handled using LASER, being a conservative management option, especially in such patients. The histopathological examination confirmed it to be a pyogenic granuloma. The paper describes the management of such lesions using LASERS as minimally invasive surgical techniques. It also tries to establish a hypothesis of a possible pathogenic association between intraoral pyogenic granuloma and thalassemia.

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.

Immunohistochemistry for FOSB and FOS is a Useful Ancillary Tool in the Diagnosis of Epithelioid Hemangioma but There are Pitfalls in Interpretation Including Expression in Other Vascular Lesions.

Introduction. Epithelioid hemangioma is a benign vascular neoplasm associated with FOS and/or FOSB protein overexpression detected by immunohistochemistry (IHC). Methods. The aim of our study was to determine the co-expression or independent IHC expression of FOS and FOSB in a cohort of epithelioid hemangiomas. We also included two cohorts of other vascular lesions: papillary endothelial hyperplasia and lobular capillary hemangioma / pyogenic granuloma. Results. We identified 50 cases of epithelioid hemangioma, 84% of which were cutaneous and the remaining involved other anatomic locations. Over two thirds of all cases expressed FOSB (68%; 34/50) while FOS immunoreactivity was identified in 46% of all cases. Co-expression of FOSB and FOS occurred in 37% of cases while 76% of all cases stained for at least one of the antibodies. Fifty-eight percent (n = 14/24) and 33% (8/24) of all cases of papillary endothelial hyperplasia expressed FOS and FOSB, respectively. Thirty-two per cent of lobular capillary hemangiomas (n = 8/25) were positive for either FOS or FOSB. Conclusion. In summary, we present the largest cohort of epithelioid hemangiomas assessed with both FOS and FOSB and demonstrated that the use of both antibodies increases the detection rate of these proliferations by 10%. Nonetheless, the use of thresholds may not be appropriate, as only a subset of lesional endothelial cells label with FOS/FOSB. Over half of all cases of papillary endothelial hyperplasia and a third of lobular capillary hemangiomas also displayed immunoreactivity with FOS and/or FOSB.

Sutureless and Glue Free Conjunctival Autograft in Pterygium Surgery

Objective: The objective of the study is to report a newer technique of pterygium excision followed by suture less and glue free conjunctival autograft for its complications and recurrence rate. 
 METHODS: This prospective and quassi experimental study was carried out at Baqai medical university hospital, Karachi from January 2016 to December 2016. This study consists of 30 eyes of 22 patients, above 15 years of age with primary progressive Pterygium of 2 mm or more in size and interfering with the vision. All the patients were operated under sub tenon’s anesthesia, Pterygium was excised with surgical blade followed by suture less and glue free conjunctival autograft from superior limbus. Primary outcomes measures included graft loss, granuloma and any other complications noted within six months. Recurrence was also noted at 6 months.
 RESULTS: There were 30 eyes of 22 patients. There were 4 females (18.18%) and 18 male patients (81.81%). The mean age was 31.28 years ± 9.4 SD. Right eye was seen in 16 (53%) cases. Graft lost was recorded in 1 patient (4.5%), conjunctival pyogenic granuloma in 1 patient (4.5%) and graft retraction was seen in 1 (4.5%) case. Recurrence rate was none at 6 months post operatively.
 CONCLUSION: Conjunctival autograft without suture and glue is a new and simple technique that can be done with minimal expenses and limited resources. It has fewer complications and no recurrence.

Gingival and alveolar ridge overgrowths: A histopathological evaluation from Saudi Arabia

BackgroundFocal tissue overgrowths on the gingiva and edentulous alveolar ridge are occasionally perplexing to periodontists, owing to the wide variety of differential diagnoses that may be responsible. As such, biopsy and microscopy are often required to establish a definitive diagnosis. The present study aimed to retrospectively evaluate focal gingival and alveolar ridge overgrowths at a single institution in Saudi Arabia. Materials and MethodsHistopathology reports and slides from patients presenting to King Saud University Hospital between 1984 and 2016, particularly those with focal gingival enlargements other than those due to gingivitis and periodontitis, were collected and analyzed based on age, sex, and location. ResultsA total of 624 patient records were evaluated, with a mean age of 35 years (range, 1 week–91 years), peak incidence in the third decade of life, male-to-female ratio of 1:1.4, and a slightly higher prevalence of lesions in the mandible. The majority (88%) of the lesions were reactive or hyperplastic, followed by malignant (10%) and benign (2%) tumors. A total of 24 distinct histological entities were diagnosed across the three groups. The most common histologically diagnosed lesions were pyogenic granulomas (38%), fibromas (33%), peripheral ossifying fibromas (9%), squamous cell carcinomas (7%), peripheral giant cell granulomas (6%), neurofibromas (1%), and non-Hodgkin lymphomas (1%). ConclusionSimilar to what has been reported by most previous studies, reactive hyperplastic lesions were the most prevalent focal overgrowths found in the gingival and alveolar mucosae. Carcinomas at these sites, however, may be an understated but significant clinical and epidemiological problem in Saudi Arabia. Gingival and alveolar ridge lumps can serve as a nexus for cooperation between periodontologists and oral pathologists to improve diagnosis, disease classification, and patient management.

Dental MRI of Oral Soft-Tissue Tumors-Optimized Use of Black Bone MRI Sequences and a 15-Channel Mandibular Coil.

Soft-tissue lesions in the oral cavity, one of the most common sites for tumors and tumor-like lesions, can be challenging to diagnose and treat due to the wide spectrum from benign indolent to invasive malignant lesions. We report an abnormally large, rapidly growing hyperplastic lesion originating from the buccal mucosa in a 28-year-old male patient. Clinical examination revealed a well-circumscribed, smooth-surfaced, pinkish nodular lesion measuring 2.3 × 2 cm, which suggested the differential diagnosis of irritation fibroma, pyogenic granuloma, oral lipoma, and other benign or malignant neoplasms such as hemangioma, non-Hodgkin’s lymphoma, or metastases to the oral cavity. Dental MRI using a 15-channel mandibular coil was performed to improve perioperative radiological and surgical management, avoiding adverse intraoperative events and misdiagnosis of vascular malformations, especially hemangiomas. Black bone MRI protocols such as STIR (short-tau inversion recovery) and DESS (double-echo steady-state) were used for high-resolution radiation-free imaging. Radiologic findings supported the suspected diagnosis of an irritation fibroma and ruled out any further head and neck lesions, therefore complete surgical resection was performed. Histology confirmed the tentative diagnosis. This article evaluates the use of this novel technique for MR diagnosis in the perioperative management of soft-tissue tumors in oral and maxillofacial surgery.

Recurrent Alterations in the MAPK pathway in Sporadic Pyogenic Granuloma of Childhood.

Pyogenic granuloma is one of the most common vascular tumours. The cause of pyogenic granuloma was previously thought to be an inflammatory reaction with consecutive stimulation of endothelial cell proliferation. However, recent studies suggest that pyogenic granuloma may be driven by constitutive activation of the mitogen-activated protein kinase pathway. The aim of this study was to investigate the molecular profile of sporadic pyogenic granuloma of childhood, using a systematic approach scrutinizing potential aberrations within different oncogenic pathways. Within a retrospective setting pyogenic granuloma of 15 patients was analysed by targeted next generation sequencing using the Oncomine Focus Assay, which includes genes of key tumorigenic signalling pathways. Activating mutations were found in 4 out of 15 cases (27%). Two HRAS hotspot mutations (p.Gly13Arg, p.Ala59Thr), 1 BRAF (p.Val600Glu) mutation and a novel, previously not reported, MAP2K1 hotspot mutation (p.Glu203Lys) were identified. It is notable that all of these genes are involved in constitutive mitogen-activated protein kinase signalling. This study increases the range of underlying genetic alterations in pyogenic granuloma by identifying novel oncogenic mutations in crucial mitogen-activated protein kinase pathway genes. The results provide supporting evidence that activated mitogen-activated protein kinase signalling is a key driver in the pathogenesis of pyogenic granuloma, which might be exploited by targeted treatment approaches for selected cases.

A clinical study on prevalence and management of eyelid tumours – A prospective observational study

To study the incidence of eyelid tumours pertaining to age, sex, lid, globe or orbital involvement and analyse the various aspects of treatment modalities and their functional and cosmetic outcome. A prospective study of 40 cases of eyelid tumours over a period of 1 year, both benign and malignant eyelid lesions were included and those with inflammatory lesions were excluded. Patients were evaluated and treated with appropriate modalities and the outcome was analysed. Malignant tumours were common in the age group between 60-85 years and benign tumours were common in the age group of 30-45 years. Benign tumours were more common among males and malignant tumours more common among females. Out of the 40 cases, 28 (70 %) eyelid lesions were benign and 12 (30%) cases were malignant. Benign tumours were found more commonly in the upper lid and malignant tumours in lower lid. Squamous papilloma was found to be the most common benign tumour, followed by pyogenic granuloma. Meibomian carcinomais the most common malignant tumour. Most common presentation of malignant eyelid tumour was ulcerative growth pattern. Meibomian carcinoma presented in the form of nodule and ulcerative growth pattern. The treatment for most of the benign tumour was simple excision and malignant tumour was wide local excision with 4-5 mm margin clearance. Glabellar rotation flap was performed in one case of meibomian carcinoma involving the medial aspect of lower lid after excision. Hughes tarso-conjunctival flap was performed in two cases of squamous cell carcinoma and basal cell carcinoma, after tumour excision as the defect involved more than 75% of the lower lid without involvement of canthus. Two cases one each of sebaceous carcinoma and squamous cell carcinoma involving the lateral aspect of lower lid was reconstructed after excision, with Tenzel flap. In one case of sebaceous gland carcinoma with diffuse involvement of the upper lid the was excised and reconstructed with Cutler-Beard technique.Histopathologic examination of all excised lesion must be done as an innocuous looking lesion might be malignant. Early clinical suspicion of malignancy and confirmation by incisional biopsy will aid in planning wide excision and appropriate method of lid reconstruction depending on the amount of lid loss. After wide excision of malignant tumour appropriate lid reconstruction technique is done as a primary procedure in all our patients and we could obtain good outcomes with no recurrences. Advanced tumours with orbital involvement and recurrent tumour need adjuvant chemotherapy or radiotherapy.

Topical treatment of pyogenic granulomas in a pediatric population: A single-institution retrospective review

To the Editor: Pyogenic granulomas (PG) are common benign vascular proliferations of the skin and mucous membranes. Because of their propensity to grow and bleed, surgical management is favored, but it can be costly, traumatic, result in scarring, or require an in-office or operative suite setting. Noninvasive treatment modalities include topical beta-blockers,1 imiquimod,2 and corticosteroids.3 By promoting vasoconstriction and downregulating proangiogenic factors such as vascular endothelial growth factor A, matrix metalloproteinase 1, and interleukin 6, topical corticosteroids potentially target several key pathways implicated in the PG pathogenesis.

An unusual case of pediatric embryonal rhabdomyosarcoma with subsequent diagnosis of neurofibromatosis type 1

A 10-month-old girl presented with a 4-month history of a rapidly growing lesion on the lower lip. Initial assessment and Doppler ultrasound supported a diagnosis of pyogenic granuloma. However, emergent biopsy revealed an embryonal rhabdomyosarcoma, a highly malignant tumor commonly associated with cancer-susceptible syndromes including neurofibromatosis type 1 (NF1). Despite having no apparent clinical features of NF1 at initial presentation, she was later found to have multiple café-au-lait spots and a subsequent diagnosis of NF1 was made.

PERIPHERAL OSSIFYING FIBROMA - A CASE REPORT

Peripheral ossifying fibroma is a benign neoplasm that usually develops from gingiva, presenting as an exophytic smooth surfaced pink or red nodular mass that is sessile or is less frequently seen on a pedicle. From the Indian perspective, it is usually noticed in 5th–6th decades of life with female predilection. Microscopically, the tumour shows stratified squamous epithelium and highly cellular fibrous stroma, sparse endothelial proliferation with fibroblasts and dystrophic calcifications. It has to be differentiated histopathologically from pyogenic granuloma, fibroma, peripheral giant cell granuloma, peripheral odontogenic fibroma and fibrous hyperplasia. A case of peripheral ossifying fibroma of mandibular gingiva in a 70-year-old Indian woman is reported.