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The authors present a case of pyogenic granuloma (botriomycome) of the vocal cord secondary to naso-tracheal intubation. Along with a physiological review, the histological and clinical characteristics of vocal cord pyogenic granuloma are discussed. Preventative measures and a treatment protocol are proposed.
PURPOSE: To report two cases of pyogenic granuloma following silicone punctal plugs. METHODS: Interventional case reports. RESULTS: The authors report two cases of pyogenic granuloma secondary to silicone punctal plugs and their lacrimal sequelae following surgical removal in one case and conservative treatment with removal of the plug alone in another. The former case developed no lacrimal sequelae while the second case developed punctal scarring. Spontaneous loss of plugs was common to both the cases. CONCLUSIONS: Patients with punctal plugs should be informed about plug-related problems and encouraged to report them.
A case of chronic Actinomyces canaliculitis with associated pyogenic granuloma formation and bloody tears is described. Although Actinomyces is a well-known cause of canaliculitis, the authors are not aware that it has been reported in association with pyogenic granulomas.
Nasal packing is a very common procedure in the otolaryngologic service for nasal bleeding and postoperative hemostasis. However, a pyogenic granuloma complicated from nasal packing has not been reported in the literature. A 50-year-old man underwent nasal packing by use of vaseline gauze due to nasal bleeding. Two weeks later, a dark brown nasal tumor was found in his nasal cavity. He underwent partial turbinectomy for removal of the tumor. The pathology demonstrated a pyogenic granuloma. It is the first case of a confirmed pyogenic granuloma complicated from nasal packing in the literature. To prevent complications and decrease the discomfort, we strongly recommend the use of inflatable balloons or nontraumatic materials for nasal packing.
A case of a giant pyogenic granuloma of the inferior turbinate secondary to nasal packing is presented and its removal via an endoscopic approach is detailed. The sinus endoscope provides excellent visualization and operative control during excision, obviating the need for a lateral rhinotomy. Pyogenic granulomas of the posterior nasal cavity are rare, and should be considered when a nasal mass is detected after packing for epistaxis.
An unusual case is reported of a hypervascular pyogenic granuloma arising from the mandible which continued to grow postpartum in a person with an associated port-wine nevus. Microembolization of the lesions permitted complete surgical removal with minimal blood loss. This case supports the theory of arteriovenous anastomosis being associated with the pathogenesis of pyogenic granulomas.
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Cutaneous metastases may be the first sign of a previously undiagnosed visceral malignancy or the initial presentation of a recurrent neoplasm. Rarely, skin metastases can resemble a pyogenic granuloma. Three oncology patients who developed new pyogenic granuloma-like cutaneous lesions are described. Histopathologic examination showed metastatic visceral malignancy in the skin. The characteristics of the previously reported cancer patients with metastatic tumor to the skin that mimicked a pyogenic granuloma are reviewed. A biopsy of a skin lesion that clinically appears to represent a pyogenic granuloma should be performed for microscopic examination in patients with a previous visceral malignancy or in cancer-free individuals whose lesions do not resolve after conservative treatment.
The expression of vascular endothelial growth factor (VEGF) was analysed in biopsy samples from patients with pyogenic granuloma. The results disclosed the presence of a strong VEGF signal in pyogenic granulomas, which are constituted by a vast majority of cells of endothelial lineage. A marked positivity was evident in areas of proliferating endothelial cells without vessel lumen formation. In the same respect, staining for VEGF was less marked in the vessels with a well-developed lumen. The fact that VEGF production appears to be limited to endothelial cell precursors or immature endothelial cells prior to the complete development of the vessels, leads to the possibility that VEGF may act as an autocrine factor in circumstances of endothelial cell stimulation.
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The "densities" of mast cells (MCs) in six kinds of vascular proliferation, pyogenic granuloma, portwine stain, cavernous hemangioma, cherry angioma, Kaposi's sarcoma, and malignant hemangioendothelioma (MHE), measured per mm2 were studied using respective specimens prepared with tryptase stain and a personal computer. The average densities of MCs in pyogenic granuloma and MHE were 103.5 +/- 25.2/mm2 (n = 10) and 106.3 +/- 40.2/mm2 (n = 10) [mean +/- standard deviation (SD)]; that in normal skin was 6.85 +/- 4.9/mm2 (n = 20) (mean +/- SD). is a significant difference [t-test (p < 0.0001) and Wilcoxon-test (p < 0.01)]. The results in portwine stain (n = 4), cavernous hemangioma (n = 9), cherry angioma (n = 4), and Kaposi's sarcoma (n = 4) were 68.6 +/- 28.9/mm2, 105.7 +/- 56.9/mm2, 85.3 +/- 45.6/mm2, 82.2 +/- 28.4/mm2 (mean +/- SD), respectively, all of which were greater than that in normal skin by a simple comparison. The results of immunofluorescence microscopy were positive with basic fibroblast growth factor staining in the tissues of pyogenic granuloma, Kaposi's sarcoma and MHE. These facts may morphologically indicate a role of MCs in the angiogenesis of these vascular tumors.
The presence of a rapidly growing intranasal mass in a child is an alarming clinical sign that requires adequate clinical and radiological assessment and prompt histological diagnosis. We present two cases of children with unilateral intranasal pyogenic granulomas. There is only one previous report of this histological diagnosis in the nasal cavity in children. Pyogenic granuloma of the nasal cavity is rare. Pyogenic granuloma should be included in the differential diagnosis of an intranasal mass in the paediatric age group.
A clinico-pathologic case of a pyogenic granuloma is reported in a 34-year-old male patient. Clinically, a nodular painless reddish tumour with a fibrinous membrane covered top, developed at the right caruncle. After surgical excision, the histopathological study established the diagnosis of a pyogenic granuloma, partially covered by a conjunctival epithelium, and a fibrinous membrane at its top.
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A case of pyogenic granuloma of the prepuce is presented. This to our knowledge, is the first reported case of this condition affecting this site.
Based on clinical features alone, pyogenic granuloma can be difficult to differentiate from a peripheral giant cell granuloma, a more aggressive oral lesion that could have consequences such as teeth displacement and alveolar bone resorption. A thorough clinical and radiographic examination is important to determine whether teeth and/or bone are involved. Furthermore, the early onset of puberty in females may increase the prevalence of pyogenic granuloma at a young age.
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A clinical analysis of 304 cases of pyogenic granuloma (excluding pregnancy tumour) were obtained from the clinical evaluations submitted by clinicians while sending specimens for biopsy. The average age of the patients with pyogenic granuloma was 28.9 years with a peak age incidence in the second decade. More female patients were affected and the lesions present mainly in the Chinese. The majority of the lesions were ulcerated and pedunculated. The lesions had a mean diameter of 10.8 mm with a mean lesion duration of 6.0 months. The gingiva was the prevalent site for these lesions with a greater number being located in the maxilla. The recurrence rate was found to be 14.1%.