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Multiple pyogenic granuloma demonstrated by SPECT using 99Tcm-labelled red blood cells.

Pyogenic granuloma is a polypoid form of capillary haemangioma that occurs on the skin and mucosal surface. The eruption of multiple pyogenic granuloma is a rare phenomenon. We report the case of a 73-year-old male with a 2 year history of intermittent lower gastrointestinal bleeding. 99Tcm-labelled red blood cell scintigraphy was performed to rule out the possibility of capillary haemangioma on the mucosal surface of the gastrointestinal tract. The images showed disseminated haemangiomas involving the skull, abdominal wall, intestine, scrotum and right leg. The final diagnosis of multiple pyogenic granuloma was made by skin biopsy. To the best of our knowledge, this is the first case using 99Tcm-labelled red blood cell scintigraphy to demonstrate multiple pyogenic granuloma.

Aged↗

Pyogenic granuloma.

A retrospective review of cases of pyogenic granuloma seen at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 1984-1991 is described. Epidemiology and the factors that led to the granuloma formation were examined and only cases documented histopathologically were included in the review. Of the 110 cases, 80% developed the granuloma at the site of the previous surgery (especially entropion repair, and dacryocystorhinostomy with a stent tube or with a Jones tube) while 20% did not have a prior surgery. Recurrence occurred in 7% and these patients were in the group who had a prior surgery. Surgical procedures lead to an increased tendency for the formation of pyogenic granuloma due to different mechanisms acting via a mechanical or chemical irritation and an inhibition of re-epithelialization.

Adolescent↗

[Pyogenic granuloma following eye muscle surgery].

BACKGROUND: A pyogenic granuloma developing after eye muscle surgery is a rare complication. It can impair aestethical results and ocular motility. PATIENT AND METHODS: A 7-year-old girl presented in our department with recurrence of a conjunctival granuloma following a bimedial retroequatorial myopexia an excision of conjunctival suture granuloma in the left eye. Clinically, a nodular painless and reddish mass was found at the nasal limbus in the interpalpebral zone. Other results of ocular examinations were limitation of adduction and elevation, mild amblyopia (visual acuity 0.8) due to microstrabismus of 1 degree. After surgical excision following the initial biopsy, the histopathologic study established the diagnosis of pyogenic granuloma. After recessing residual conjunctiva and Tenon's fascia in 10 mm distance from the limbus the conjunctiva was fixed to the sclera. The sclera between the limbus and the conjunctiva was left uncovered. Reepithelialisation of the bare sclera occurred after few days. RESULTS: No further symptoms were observed during a follow-up time of 1 year. CONCLUSIONS: The rapid growth and appearance as well as the clinical examination may imitate another tumor necessitating surgical excision and histopathological study. Bare sclera-technique is a suitable method for plastic reconstruction.

Child↗

[Pyogenic granuloma revealing fistula and deep infection: five cases].

BACKGROUND: Pyogenic granuloma, or botryomycosis, occurring after minor injury or scratching with a septic implement, is a rapidly growing benign inflammatory vascular tumour, often involving the skin or mucous membrane. We report 5 unusual cases of pyogenic granuloma revealing fistula tracking to foreign bodies such as a pace-maker or orthopaedic material, and deep infectious sites with fistula. METHODS: This retrospective study included 5 men of average age 72.2 years over a period of 22 years (between 1981 and 2003). Clinical images were recorded and a diagnosis of botryomycosis was confirmed in all patients by histological analysis. Four patients presented suppuration. The time from initial clinical signs to diagnosis, presence of traumatic events, screening for microscopic organisms, response to systemic antibiotic therapy, recurrence and clinical features of botriomycosis were analysed. RESULTS: All patients presented botryomycosis with fistula and suppuration revealing deep bone infection and in one patient, pace maker infection. Complete resolution of the lesions occurred after excision of foreign material and prolonged systemic antibiotic therapy. CONCLUSION: We report the first series of botryomycosis revealed by fistula and showing deep infectious disease. Pyogenic granuloma is a well-known but rarely reported dermatologic condition.

Aged↗

Non-oral pyogenic granuloma in pregnancy: a report of two cases.

BACKGROUND: Pyogenic granulomas are benign vascular lesions of the skin or mucous membranes. Oral lesions are believed to occur in up to 2% of pregnancies. To the best of our knowledge, non-oral lesions in pregnancy have not been reported in the obstetric literature. CASES: We report two cases of non-oral pyogenic granuloma in pregnancy. The first, involving a finger lesion in a woman with triplets, demonstrated rapid growth and recurred after surgical excision. The second was an inguinal crease lesion, which was excised successfully after becoming symptomatic. CONCLUSION: Clinical experience suggests that the prevalence of pyogenic granulomas in pregnancy is not as high as has been reported in the literature. The relation of non-oral lesions to pregnancy is unknown.

Adult↗

Human herpesvirus 8 (HHV-8) detected in two patients with Kaposi's sarcoma-like pyogenic granuloma.

AIMS: To report the finding of human herpesvirus 8 (HHV-8) in two patients with Kaposi's sarcoma (KS)-like pyogenic granuloma. This form of pyogenic granuloma closely resembles KS histologically and it has been reported that immunohistochemistry in such lesions may be positive for smooth muscle actin and factor VIII related antigen, which are typically negative in KS. In both patients the lesions were positive for CD31, CD34, smooth muscle actin, and factor VIII related antigen, a profile typical of KS-like pyogenic granuloma. The lesions were tested for the presence of HHV-8 DNA, which to date has been consistently found in all types of KS. METHODS: The lesions were tested for the presence of HHV-8 DNA using the polymerase chain reaction (PCR). A known HHV-8 positive KS specimen was used as the positive control. Six samples of non-KS vascular skin lesions were used as negative controls for the PCR reaction. RESULTS: Both lesions were positive on PCR for HHV-8 and the specificity of product was confirmed by direct sequencing. None of the six control vascular skin lesions was positive for HHV-8. These results strongly indicate KS as the true diagnosis and are supported by the reported clinical course in both cases. CONCLUSIONS: Techniques targeting HHV-8 DNA for detection to confirm a diagnosis of KS are both sensitive and specific. In cases where the differential diagnosis includes KS-like pyogenic granuloma, caution should be taken not to diagnose solely on the basis of immunohistochemistry phenotype. In such cases, PCR targeting HHV-8 DNA sequences is a better diagnostic tool.

Aged↗

Intravascular pyogenic granuloma arising in an acquired arteriovenous malformation: report of a case and review of the literature.

BACKGROUND: Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular skin tumor. Intravascular variant of this vascular tumor is rare and such a variant arising in another hemangioma is extremely unusual. OBJECTIVE: The objective was to present a patient with an intravascular pyogenic granuloma arising in an acquired arteriovenous malformation of the palm. METHODS: We report a case and review the literature. RESULT: A 44-year-old woman presented with an easy-bleeding and ulcerative nodule with a hyperkeratotic collaret on her right palm for 3-4 months. The nodule measured 6 x 6 mm in size and was tender. Under the clinical impression of pyogenic granuloma, the lesion was totally excised and the microscopic examination revealed an intravascular pyogenic granuloma in the papillary dermis with an underlying arteriovenous malformation. CONCLUSION: A rare composite vascular tumor is reported, and our case presented as a red eroded nodule surrounded by a keratotic collaret, which was easily misdiagnosed as pyogenic granuloma clinically. We suggest that any pyogenic granuloma-like lesion should be palpated carefully, and if a nodule is present, surgical excision rather than cryotherapy or laser ablation should be considered.

Adult↗

Successful treatment of pyogenic granuloma with injection of absolute ethanol.

Pyogenic granuloma (PG) is a small, almost always solitary, sessile or pedunculated, raspberry-like vegetation of exuberant granulation tissue. Conservative treatment by techniques such as cryosurgery, laser surgery, and electrodesiccation are usually adequate, whereas excisional treatment can often result in noticeable scars. We attempted a different approach using an injection of absolute ethanol in five patients with recurrence due to inadequate cryosurgery. This therapy is less invasive than surgical excision and appears to be an alternative therapy for PG.

Adult↗

Pyogenic granuloma caused by exposed sternotomy wires.

BACKGROUND: This case describes a 75-year-old African American man who developed a pyogenic granuloma on the chest due to trauma induced by exposed sternotomy wires from his coronary bypass procedure. OBJECTIVE: To describe a previously unreported cause of pyogenic granuloma. MATERIALS AND METHODS: The pyogenic granuloma was excised and during the procedure, exposed sternotomy wires were uncoiled at the base of the lesion. The sternotomy wires were retightened and reappositioned along the sternum, and the wound was closed primarily. RESULTS: The pyogenic granuloma has not recurred after 15 months of follow-up. CONCLUSIONS: Pyogenic granulomas are vascular benign tumors that commonly appear secondary to trauma. The source of the trauma in this case was the exposed sternotomy wires.

Aged↗

Dermoscopic findings in pyogenic granuloma.

BACKGROUND: To the best of our knowledge, no specific dermoscopic criteria have been described in the medical literature for the diagnosis of pyogenic granuloma. OBJECTIVES: To evaluate the morphological findings of pyogenic granuloma under dermoscopic observation. METHODS: Dermoscopic examination (using the DermLite Foto; 3Gen, LLC, Dana Point, CA, U.S.A.) of 13 patients with pyogenic granulomas was performed to evaluate specific dermoscopic criteria. RESULTS: The most frequently occurring dermoscopic features were found to be: reddish homogeneous area (92%), white collarette (85%), "white rail" lines that intersect the lesion (31%) and ulceration (46%). The results of our study reveal that the absence of specific dermoscopic criteria for other skin tumours and a reddish homogeneous area surrounded by a white collarette are the most frequent dermoscopic pattern in pyogenic granulomas (85%). CONCLUSIONS: Dermoscopy is a useful tool for improving the recognition of pyogenic granuloma.

Adolescent↗

Pyogenic granuloma (lobular capillary hemangioma) of the tongue.

A patient with a pyogenic granuloma which occurred in an unusual location and at an earlier age is presented. Pyogenic granuloma is not an uncommon entity which may occur on oral mucosa, face and fingers. The most frequent location encountered for oral cavity pyogenic granuloma is the gingiva and the tongue is a rare location for its occurrence. These lesions are usually seen between 11 and 40 years age. Surgical excision and removal of etiological factors are needed for treatment.

Granuloma, Pyogenic↗

Pyogenic granuloma of the hand.

Pyogenic granuloma is a benign, vascular lesion occasionally seen on the hand. It many be quite alarming to the patient. Adequate surgical excision is advocated as the treatment of choice.

Adult↗

Immunocytochemistry of eruptive haemangiomas (pyogenic granulomas).

Eight eruptive haemangiomas (pyogenic granulomas) were stained immunocytochemically. Many of the cells reacted with markers for endothelial cells. The reactions with anti-vWF antibody were weaker than those with UEA-I-lectin and with the monoclonal antibody BMA 120. These results probably reflect reduced capability for storage of vWF by proliferating endothelial cells. Many cells were negative for endothelial-cell markers, and they reacted with a monoclonal antibody against muscle actin. These cells may be myofibroblasts and pericytes. The studies indicate that eruptive haemangiomas are composed of pericytes, myofibroblasts and endothelial cells.

Hemangioma↗

Treatment of pyogenic granulomas with the 585 nm pulsed dye laser.

BACKGROUND: Current therapeutic alternatives for pyogenic granulomas include surgical excision, electrodesiccation and curettage, cryotherapy, and ablation with CO2 or continuous-wave vascular lasers. OBJECTIVE: Our purpose was to investigate the use of the 585 nm flashlamp-pumped pulsed dye laser (585 nm PDL) for the treatment of pyogenic granulomas in terms of efficacy, advantages in technique, and side effects. METHODS: Eighteen patients with symptomatic pyogenic granulomas in a variety of locations were treated with the 585 nm PDL and examined. RESULTS: Sixteen of 18 treated patients demonstrated both symptomatic and clinical clearing of the lesions with excellent cosmetic results after treatment. The two patients who dropped out after one to two 585 nm PDL treatments were eventually treated successfully with electrodesiccation and curettage. No postoperative complications and no persistent pigmentary changes or scarring were observed. The procedure required no anesthesia, and postoperative care was limited to the application of a topical antibiotic ointment. CONCLUSION: Our experience suggests that treatment of pyogenic granulomas with the 585 nm PDL is a safe, effective, and reasonable alternative to conventional therapy.

Administration, Cutaneous↗

Pyogenic granuloma: a rare complication of silicone punctal plugs.

To describe pyogenic granuloma formation associated with silicone punctal plugs. A 65-year-old woman with severe dry eye was treated with silicone punctal plugs in both upper and lower puncta. After 14 months of success with the plugs, the patient presented with a fleshy ampullary lesion overlying the plugged superior punctum of her right eye. It was clinically diagnosed as a pyogenic granuloma, and the silicone plug was removed. Since the lesion persisted for 1 month, it was surgically removed. Histopathologic examination confirmed the diagnosis of pyogenic granuloma. A new plug was inserted and tolerated well. The routine use of silicone plugs are recommended as long as patients are informed of possible rare complications.

Aged↗

An exaggerated response of intra-oral pyogenic granuloma during puberty.

Intra-oral pyogenic granulomas have been associated with pregnancy. The exaggerated response of these tumors has been related to the hormonal changes occurring during this period. A change in the hormonal balance also occurs during puberty. In this paper, we present two young patients with large pyogenic granulomas and suggest that the hormonal changes play a primary role in the pathogenesis of this tumor.

Child↗

Pyogenic granuloma of the cornea: report of a case and review of the literature.

BACKGROUND: Pyogenic granulomas are ulcerated vascular proliferations, often accompanied by inflammatory infiltrates, which rarely affect the eye. Only few reports on pyogenic granulomas of the cornea have been presented. METHODS: The enucleated globe containing the corneal tumor was examined histopathologically, and special immunohistochemical stains were performed. RESULTS: The lesion had a yellowish appearance with marked vascularization. The inflammatory infiltrate was mainly composed of mononuclear cells, with no multinucleated giant cells, and was located anterior to Bowman's layer, leaving the corneal stroma unaffected. Immunohistochemical studies outlined the high vascular content, even in dense cellular areas, and confirmed the inflammatory nature of the mononuclear infiltrates. CONCLUSIONS: Pyogenic granuloma of the cornea represents a clinical and morphological entity developing in a traumatized eye with corneal vascularization. Although the origin of these lesions remains obscure, there have been no signs of malignancy. Therefore, enucleation of an eye with a pyogenic granuloma should be avoided.

Aged↗

Multiple pyogenic granuloma of the penis.

A case of multiple pyogenic granuloma affecting the penis of a 28 year old man is reported. The lesions were arranged in a floret-like fashion around the inner aspect of the prepuce and developed after circumcision for congenital phimosis. Histopathological examination of sections from a biopsy specimen of the papillomatous growths revealed the findings of pyogenic granuloma. In this patient, the pathogenesis of the lesions is probably related to the failure in surgical wound repair that followed circumcision. Problems of clinical and histopathological differential diagnosis are discussed.

Electrocoagulation↗