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A case of pyogenic granuloma involving the cornea simulated recurrent squamous cell carcinoma clinically and was misdiagnosed as invasive squamous cell carcinoma on biopsy. Ophthalmologists and pathologists should be aware of the capability of the corneal or conjunctival tissues to mount a granulation tissue response to injury.
A pyogenic granuloma occurred in a port-wine stain treated with first an argon, and subsequently a carbon dioxide, laser. Although reports of this phenomenon are infrequent in the literature, our review suggests that this is not a rare complication. The pathogenetic implications are discussed.
We report a pyogenic granuloma of the upper palpebral conjunctiva in a soft contact lens user. Pathological examination revealed numerous foreign bodies embedded within the specimen. The contact lens may have contributed to development of the lesion.
Pyogenic granuloma (PG) has a diagnostic, lobular arrangement of capillaries at its base. The lobules consist of discrete clusters of endothelial cells, and the lumina vary from indistinct to prominent. The superficial portions of the lesion may undergo secondary, nonspecific changes including stromal edema, capillary dilation, inflammation, and a granulation tissue reaction. PG has often been equated with these inflammatory changes but objective diagnostic criteria have not been presented. To avoid confusion and focus on the intrinsic nature of PG we suggest the accurate, descriptive term, lobular capillary hemangioma (LCH). A review of 639 vascular lesions of the oral cavity and upper respiratory tract yielded 73 cases with the characteristic features of LCH. The lip was the most common site (38%), followed by the nose (29%), oral mucosa (18%), and tongue (15%). LCH usually presents as a spontaneous, painless, bleeding mass. There is a predilection for males less than 18 years old, females in the reproductive years, and an equal sex distribution beyond 40 years of age. No examples of LCH were found in 68 vascular lesions from the larynx or trachea.
An atypical fibroxanthoma on the ear of a 82-year-old man appeared clinically as a pyogenic granuloma. Histopathologically, the lesion had been interpreted as a malignant melanoma before its true nature was identified. Familiarity with this cutaneous pseudomalignant growth is essential to prevent radical surgical procedures.
A 15-month-old baby girl with extensive skin burns developed within the burned areas multiple lesions with the clinical and histological characteristics of granuloma pyogenicum. These lesions seem to differ from those reported by others as pyogenic granuloma with multiple satellites.
An unusual complication of papaverine injection therapy is reported. A pyogenic granuloma formed after a single test dose of papaverine. Diagnosis, therapy and course of the patient are outlined.
Bone formation in angiomatous naevi such as strawberry naevi is recorded (Rook, 1972) but as far as we are aware ossification in a cutaneous pyogenic granuloma has not been reported.
We report the case of two siblings, one of whom presented isotretinoin-induced eruptive pyogenic granulomas in the course of severe acne, and the other developed isotretinoin-induced acne fulminans. A possible underlying common pathogenic process of these two side-effects of isotretinoin is discussed.
To examine the role of metalloproteinases in tissue remodeling associated with wound healing, we used in situ hybridization to localize the expression of collagenase and tissue inhibitor of metalloproteinases (TIMP) in samples of pyogenic granuloma. Strong hybridization for collagenase mRNA was detected in basal keratinocytes near the advancing edge of all ulcerative lesions, but no collagenase mRNA was seen in samples without ulceration. Distinct from the sites of collagenase expression, TIMP mRNA was detected in stromal cells and in cells surrounding proliferating vessels. No collagenase mRNA was found in the epidermis of healthy skin, although occasional stromal cells contained collagenase or TIMP mRNAs, and TIMP mRNA was detected in hair follicles and sebaceous glands. Our results suggest that basal keratinocytes adjacent to wounded epidermis are critically involved in matrix remodeling, much more so than adjacent or underlying dermal fibroblasts. Furthermore, as several reports have suggested, TIMP may play a role in angiogenesis. Finally, in contrast to findings from other models which indicate that collagenase and TIMP proteins are secreted by the same cells, our data also demonstrate that these proteins can be produced in vivo independently of each other.
A 55-year-old patient was treated with a combination of minoxidil and retinoic acid. After 1 month an explosive eruption of pyogenic granuloma appeared on the scalp. Despite redness and itchy reaction, caused only by the test containing both chemicals, histology did not give evidence of contact allergy.
A large exophytic mass was seen in the oral cavity of a 22-year-old male. Repeated biopsies of the mass showed chronic inflammation with granulation tissue. An excisional biopsy confirmed the presence of pyogenic granuloma. This lesion is unusual as it attained a very large size causing considerable facial deformity. Intraoperatively, the lesion was noted to be highly vascular. This case may prove to be of great interest to otolaryngologists who often deal with oral lesions, as it demonstrates an extreme and unusual presentation of a definitely benign lesion.
We present a case of a pregnant patient with a rapidly growing mass within the nasal fossa that was imaged by CT 2 weeks postpartum. Concern for malignancy existed and biopsy was performed, revealing pyogenic granuloma gravidarum. This uncommon lesion should be considered in any gravid patient when a mass occurs within the mouth or nasal fossa.
A cutaneous horn is a keratotic, usually conical tumor, consisting of a spire of accumulated, cohesive stratum corneum. A number of primary lesions underlying the horny material are known to cause this condition. We present an unusual case of pyogenic granuloma clinically mimicking a cutaneous horn and suggest that it be included in the initial differential diagnosis as a rare cause of this entity. We also review various known causes of cutaneous horn.
A large exophytic bone-resorbing lesion was discovered in the oral cavity of an institutionalized 33-year-old male. An excisional biopsy under general anesthesia was performed. Frozen and permanent histologic sections confirmed a reactive gingival fibroma consistent with a pyogenic granuloma. This lesion is unusual in that it attained a very large size and caused marked remodeling of the alveolar bone of the mandible. Of interest as well, this highly vascular lesion was found to have numerous feeding vessels from the alveolar bone. A retained tooth root was encountered within the lesion, presumably the etiologic factor producing this lesion. A differential diagnosis is presented and discussed. The lesion should be of particular interest to otolaryngologists who deal with intraoral lesions and their treatment, since it illustrates an extreme presentation of a totally benign process.
We treated exposure of the orbital implant with a dermis fat graft in two patients with an acquired anophthalmic orbit. During the first six postoperative months, a large polypoid tumor of the conjunctiva developed over the grafted tissue in each patient. Histologic examination of both lesions disclosed a pyogenic granuloma.
A 43-year-old man reported a 2-month history of numerous widespread vascular lesions that had developed suddenly on his scalp, trunk, and extremities. The lesions were 2 to 6 mm in diameter, firm, dark red papules that bled easily with minor trauma. Histopathologic examination of four lesions revealed lobular capillary hemangioma, also known as pyogenic granuloma. Treated lesions did not recur after surgical excision or electrocauterization. Five months after the onset of the eruption, no new lesions were developing, and some were resolving spontaneously after bleeding. Eruptive, disseminated lobular capillary hemangioma is a rare, self-limited cutaneous disorder that occurs in otherwise healthy persons.
Bacterial pseudomycosis also known as Botryomycosis is a rare, indolent infection that has been described in patients with immunodeficiency and tissue with decreased healing ability. It affects the visceral organs and infection in the head and neck has been described as affecting the tongue and jaw bones. Histologically, the disease is characterized by the presence of 'Bollinger granules', surrounded by neutrophils in a fibrocellular stroma. A case of gingival Botryomycosis is presented which was diagnosed as a routine pyogenic granuloma in a healthy male.