Pyogenic granuloma or pyogenic fibroma is a vascular tumor that occurs on both mucosa and skin, and appears as an overgrowth of tissue due to irritation, physical trauma, or hormonal factors. It is often found to involve the gums, the skin and nasal septum, and has also been found far from the head such as in the thigh.
|Other names||Eruptive hemangioma, Granulation tissue-type hemangioma, Granuloma gravidarum, Lobular capillary hemangioma, Pregnancy tumor, and Tumor of pregnancy|
Pyogenic granulomas may be seen at any age, and are more common in females than males. In pregnant women, lesions may occur in the first trimester with an increasing incidence up until the seventh month, and are often seen on the gums.
Signs and symptomsEdit
The appearance of pyogenic granuloma is usually a color ranging from red/pink to purple, grow rapidly, and can be smooth or mushroom-shaped. Younger lesions are more likely to be red because of the high number of blood vessels. Older lesions begin to change into a pink color. Size commonly ranges from a few millimeters to centimeters, though smaller or larger lesions may occur.[medical citation needed] A pyogenic granuloma can be painful, especially if located in an area of the body where it is constantly disturbed. Pyogenic granulomas can grow rapidly and will often bleed profusely with little or no trauma. They may exude an oil like substance, causing the surface to be damp. This is especially true if the granuloma is located on the scalp.[medical citation needed]
Epulis granulomatosum is a variant of pyogenic granuloma that forms only on gingiva, and is often seen forming in a recent extraction socket. Pyogenic granulomas appear on the gingiva in 75% of cases, more often in the maxillary than mandibular jaw. Anterior areas are more often affected than posterior areas. It can also be found on the lips, tongue, and inner cheek. Poor oral hygiene or trauma are usually precipitating factors.
One study has suggested a correlation between pyogenic granulomas and Bartonella seropositivity. However, this association has been questioned by others. The microscopic appearance of a pyogenic granuloma consists of highly vascular granulation tissue. Inflammation is present. The lesion may have a fibrous character if it is older, and the surface may have ulcerations. Pyogenic granulomas rarely occur in the conjunctiva, cornea or connective tissue of the eye following minor local trauma. Grossly these mass lesions resemble those occurring at more common sites. The relationship of these lesion to lobular capillary hemangiomas of skin and oropharyngeal mucosa commonly referred to as pyogenic granuloma is uncertain.
Due to its overwhelming incidence on the gingiva, the condition is often associated with two other diseases, though not because they occur together. Instead, the three are associated with each other because they appear frequently on gingiva—peripheral giant cell granuloma and peripheral ossifying fibroma. Detailed analysis can be used to distinguish these conditions.
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History typically involves 25-year-old female with a nodular ulcer with discharge over the lip. Your doctor will likely be able to diagnose a pyogenic granuloma based on its appearance. Your doctor might do a biopsy to make a more accurate diagnosis. This procedure involves taking a tissue sample. A biopsy also helps rule out malignant (cancerous) medical conditions that can cause a similar kind of growth. These conditions include squamous cell carcinoma, basal cell carcinoma, and melanoma.
Histopathological examination shows multiple capillaries (due to the vascular nature of the tumour), neutrophils( pyogenic) and necrotic tissue.
Although pyogenic granulomas are not infectious or cancer, treatment may be considered because of bleeding or ulceration. Frequently, pyogenic granulomas are treated with electrodesiccation (cauterization) and curettage (excision), though laser treatment using pulsed dye laser or CO2 laser is often effective.
Several reports have demonstrated the efficacy of topical application of the beta-adrenergic antagonist timolol in the treatment of pediatric pyogenic granuloma.
There is usually no treatment if the pyogenic granuloma occurs during pregnancy since the lesion may heal spontaneously. Recurrent bleeding in either oral or nasal lesions may necessitate excision and cauterization sooner, however. If aesthetics are a concern, then treatment may be pursued as well. Usually, only minor surgery may be needed, along with a dental cleaning for oral lesions to remove any calculus or other source of irritation. For nasal lesions, nose-picking should be discouraged.
The name pyogenic granuloma is misleading as it is neither pyogenic or a true granuloma. In actuality, it is a capillary hemangioma of lobular subtype, which is why such a lesion is prone to bleeding. It is also not truly pyogenic (pus-producing), as the cause is hormonal or traumatic and has no association with infection or pus production.
- James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6.
- Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
- Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
- Jafarzadeh H, Sanatkhani M, Mohtasham N (December 2006). "Oral pyogenic granuloma: a review". J Oral Sci. 48 (4): 167–75. doi:10.2334/josnusd.48.167. PMID 17220613.[dead link]
- Nthumba PM (2008). "Giant pyogenic granuloma of the thigh: a case report". J Med Case Reports. 2 (1): 95. doi:10.1186/1752-1947-2-95. PMC 2329656. PMID 18377654.
- Lee J, Lynde C (2001). "Pyogenic granuloma: pyogenic again? Association between pyogenic granuloma and Bartonella". J Cutan Med Surg. 5 (6): 467–70. doi:10.1007/s10227-001-0022-0. PMID 11907853.
- Levy I, Rolain JM, Lepidi H, et al. (December 2005). "Is pyogenic granuloma associated with Bartonella infection?". J. Am. Acad. Dermatol. 53 (6): 1065–6. doi:10.1016/j.jaad.2005.08.046. PMID 16310070.
- Salum FG, Yurgel LS, Cherubini K, De Figueiredo MA, Medeiros IC, Nicola FS (May 2008). "Pyogenic granuloma, peripheral giant cell granuloma and peripheral ossifying fibroma: retrospective analysis of 138 cases". Minerva Stomatol. 57 (5): 227–32. PMID 18496485.
- Pagliai KA, Cohen BA. Pyogenic granuloma in children. Pediatr Dermatol. 2004;21(1):10.
- Tay YK, Weston WL, Morelli JG. Treatment of pyogenic granuloma in children with the flashlamp-pumped pulsed dye laser. Pediatrics. 1997;99(3):368.
- Wine Lee L, Goff KL, Lam JM, Low DW, Yan AC, Castelo-Soccio L. Treatment of pediatric pyogenic granulomas using B-adrenergic receptor antagonists. Pediatr Dermatol. 2014 Mar;31(2)203–7.
- Al-shiaty, RA; Ottoman, BAE (May 2015). "Recurrent pyogenic granuloma: an update". International Journal of Scientific Reports. 1 (1): 22–31. doi:10.18203/issn.2454-2156.intjscirep20150196.
- Ferry AP, Zimmerman LE. Granuloma pyogenicum of limbus. Arch Ophthalmol 74:229–230, 1965.