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Flashlamp-pumped pulsed dye laser treatment for pyogenic granuloma.

Pyogenic granuloma is a frequently diagnosed, benign vascular lesion common in children and young adults. Treatment of pyogenic granuloma consists of removal of the lesion for therapeutic as well as diagnostic purposes. Current treatment modalities include curettage with electrodesiccation, cryosurgery, chemical cauterization, and argon laser therapy. However, these methods are not without the risk of complications such as scarring and pigmentary changes. The recently reported success of the flashlamp-pumped pulsed dye laser for treating telangiectasias, hemangiomas, and port-wine stains led us to hypothesize that this same device, using different variables, such as multiple overlapping pulses, would be of benefit in the treatment of pyogenic granuloma. We describe three patients with pyogenic granuloma treated with the pulsed dye laser, with the total number of treatments and energy densities varying according to the size of the initial lesion. All three patients demonstrated complete resolution of lesions with no evidence of scarring, atrophy, or pigment changes. This preliminary report suggests that pulsed laser therapy should be considered in the treatment of pyogenic granuloma, especially in cosmetically sensitive areas.

Adolescent↗

Oral pyogenic granulomas.

Pyogenic granulomas are benign growth occurring in various oral mucosal sites. They are thought to be caused by tissue response to non-specific irritation. Surgical excision and removal of irritants are the usual treatments, and recurrence is rare. The exception is the 'pregnancy epulis', where excision should only be considered if there is incomplete regression following childbirth.

Adult↗

The role of human papillomavirus in the development of pyogenic granulomas.

BACKGROUND: Pyogenic granulomas (lobular capillary hemangiomas) and condyloma acuminata share similar locations and risk factors. Human papillomavirus (HPV) types 6 and 11 are commonly associated with condyloma acuminata, but their association with pyogenic granulomas has not been evaluated. The purpose of this study was to determine whether pyogenic granulomas contain evidence of infection with condyloma-producing HPVs. METHODS: Polymerase chain reaction assays for the E6 and E7 gene sequences of HPV types 6 and 11 and another assay for the E7 region of HPV types 16, 31, 33, 35, 42, and 58 were used to evaluate deoxyribonucleic acid (DNA) extracted from archival pyogenic granuloma biopsies taken from cutaneous and oral epithelium. RESULTS: Neither cutaneous nor oral pyogenic granulomas contain amplifiable E6 or E7 sequences from any of these viruses. CONCLUSIONS: Pyogenic granulomas are not caused by HPV 6, 11, 16, 31, 33, 35, 42, or 58. This study does not exclude the possibility that other viruses may be responsible for these tumors.

Base Sequence↗

The detection and comparison of angiogenesis-associated factors in pyogenic granuloma by immunohistochemistry.

BACKGROUND: Pyogenic granuloma is a benign inflammatory lesion demonstrating obvious activity of angiogenesis. Female steroid hormones are believed to play important roles in the etiology because the lesion is frequently found in females with high levels of sex hormones. Few molecular mechanisms of the pathogenesis have been proposed and proven. The purpose of this study was to detect and compare the expression of angiogenesis-associated factors among healthy gingiva, gingiva from periodontitis, and pyogenic granuloma to clarify the pathogenesis of pyogenic granuloma. METHODS: Fifteen specimens were collected from each of 3 groups of gingiva (healthy gingiva, periodontitis, and pyogenic granuloma). The subjects were age and gender matched. The specimens were processed for immunohistochemistry to detect and compare the expression of 2 angiogenesis enhancers, i.e., vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), 2 angiogenesis inhibitors, i.e., angiostatin and thrombospondin-1 (TSP-1), and estrogen receptor (ER). Using the subject as the unit of statistical analysis, either analysis of variance or chi-square analysis was employed to show the statistically significant difference at a level P <0.05. RESULTS: The pyogenic granuloma group expressed significantly more VEGF and bFGF than healthy gingiva and periodontitis. The positive staining of VEGF was mostly localized in the cytoplasm of macrophages and fibroblasts while that of bFGF was in the extracellular matrix of lamina propria. Angiostatin was expressed significantly less in pyogenic granuloma than the other 2 groups and was mostly localized in the nuclei of endothelial cells and epithelial cells. There was no significant difference in the expression of TSP-1 and ER among the 3 groups. CONCLUSIONS: The results of this research suggest that the etiology of pyogenic granuloma is due to the imbalance between angiogenesis enhancers and inhibitors. Whether and how the angiogenesis-associated factors are regulated by female steroid hormones remain to be answered.

Adult↗

Pyogenic granulomas of the cornea.

Pyogenic granulomas are vasoproliferative, inflammatory lesions composed of granulation tissue, which occur on cutaneous or mucosal tissues, often arising secondary to other processes such as trauma or infection. Conjunctival pyogenic granulomas are not rare, but corneal involvement is very unusual and can occasionally lead to problems in the differential diagnosis of corneal masses. We report three cases of pyogenic granuloma involving the cornea. The clinicopathologic features of these cases and a review of the literature on the ocular manifestations of this condition are presented.

Actinomycosis↗

Pyogenic granulomas of the cornea.

BACKGROUND: Pyogenic granulomas are vascular inflammatory lesions that represent an aberrant wound healing response. They typically arise from mucous membranes or skin. Pyogenic granulomas primarily involving the cornea have been rarely reported. METHODS: Between January 1983 and July 1994, 14 patients with histologically proven pyogenic granulomas of the cornea were treated. RESULTS: The precipitating event was a persistent epithelial defect in nine patients. Ocular surface disease was present in all patients. Predisposing conditions included indolent corneal ulceration, cry eye syndrome, trachoma, trichiasis, alkali burn, multiple topical drug use, previous orbital irradiation, and ocular cicatricial pemphigoid. CONCLUSIONS: Ophthalmologists should be aware that pyogenic granulomas may involve the cornea and include this entry in the differential diagnosis of tumors involving the limbus or cornea. The typical clinical appearance, rapid growth, minimal staining with rose bengal dye, response to topical steroids, and associated ocular surface disease help to distinguish this lesion from a neoplastic epithelial tumor of the conjunctiva or cornea.

Adolescent↗

Identification and semiquantification of estrogen and progesterone receptors in pyogenic granulomas of pregnancy.

Cases of pyogenic granuloma in pregnant women, nonpregnant women, and men were evaluated for the detection of estrogen and progesterone receptor proteins by immunoperoxidase staining. Immunostaining for estrogen receptors revealed a marked immunoreactivity of the endothelium within lesional tissue and in the overlying mucosal epithelium in many cases. Progesterone receptor immunoreactivity was only present within the epithelium, where it was much less than that of estrogen receptor immunoreactivity in both quantity (proportion of positive cells) and intensity. No characteristic staining pattern or significant quantitative difference among the three study groups could be discerned. These findings suggest that the quantity of estrogen or progesterone receptors in pyogenic granuloma is not the determining factor in the pathogenesis of this lesion. Rather, such a role may be attributed to the levels of circulating hormones. The levels of estrogen and progesterone are markedly increased in pregnancy and could therefore exert a greater effect on the endothelium of the pyogenic granuloma.

Adolescent↗

Pyogenic granuloma of the cornea.

BACKGROUND: Ocular pyogenic granulomata are uncommon and are often associated with a chalazion or previous ocular and adnexal surgery The avascular nature of the cornea may explain the rarity of pyogenic granulomata at this site. We report on a case of corneal pyogenic granuloma following previous corneal surgery. METHODS: Ophthalmologists who had treated the patient previously were contacted and earlier clinical notes and histopathological examinations were reviewed. The clinical course following excision of the pyogenic granuloma is described, as are the histopathological findings. RESULTS: Histological examination confirmed the diagnosis of pyogenic granuloma. Excision was followed by a clinical recurrence at a different site with spontaneous resolution. CONCLUSIONS: Pyogenic granulomata of the cornea are rare. However, the present case illustrates the importance of considering benign inflammatory causes in the differential diagnosis of a corneal mass lesion so as to avoid unnecessarily aggressive intervention. To our knowledge, spontaneous resolution of a corneal pyogenic granuloma has not been previously described.

Aged↗

Multiple, genital lobular capillary haemangioma (pyogenic granuloma) in a young woman: a diagnostic puzzle.

A 21 year old woman presented with multiple lobulated lesions on the labia majora. The surface of most of the lesions was ulcerated revealing a glistening surface. All lesions were excised. The histopathology revealed features suggestive of lobular capillary haemangioma (pyogenic granuloma). Pyogenic granuloma is considered as a reactive hyperproliferative vascular response to trauma or other stimuli. A literature search revealed reports of a few cases of lobular capillary haemangioma of the glans penis but not on the female genitalia. This case is presented to help physicians become aware that lobular capillary haemangiomas (pyogenic granuloma) may occur at this site.

Adult↗

Reliable treatment of pyogenic granuloma of the hand.

Pyogenic granuloma (PG) is a common skin tumour whose aetiology is unknown. There is a significant recurrence rate whatever method of treatment is used, and there are many studies in the literature on the treatment of recurrence. In our experience, the most effective way of preventing recurrence is the complete removal of the tumour using the microscope, operating in a bloodless field. Only then can the whole tumour with its supply vessels be reliably removed. 20 cases of PG on the hand, three cases in the shoulder-neck area and one case on the foot have been treated in our department over a period of 4 years. Five of these were recurrences and all involved the hand. Three of these were infected. 17 patients were followed for 3 months to 3.5 years. There were no recurrences in these patients, all of whom were operated on using the method described above.

Adolescent↗

Large pyogenic granuloma: a case report.

Pyogenic granuloma is a common reactive lesion seen in the third decade of life, generally between 1 and 2 cm in size. It may be confused clinically with malignancy. It is treated by surgical excision, and recurrence is rare.

Adolescent↗

Pyogenic granuloma of the scrotum.

Pyogenic granuloma is a benign, vascular, over-exuberant, inflammatory, solitary skin tumor common in infants and children. It is a rapidly growing solitary, sessile, or polypoidal vascular nodule that will bleed easily. The exact pathogenesis of this condition is unknown. Various predisposing factors, such as trauma, hormones, infection, viral oncogenesis, microscopic anastomosis, and others may be responsible for its growth.

Adolescent↗

[Study of pyogenic granuloma of the oral cavity].

Pyogenic granuloma is one of the diseases sometimes seen in otorhinolaryngology clinics. The clinical features of this disease are understood to be that the lesion is located in the oral cavity in the majority of cases that its causative agent is usually discovered and that it most likely grows as a malignant tumor. However, the entity of pathological diagnosis has not been established. Thirty-one cases of oral pyogenic granuloma, including 16 males and 15 females, are reported in this paper. The granuloma was located most frequently at the tongue, followed, in order, by the gingiva, buccal mucosa, hard palate, lip and oral floor. The period between the patient's first visit to our clinic and the onset of his/her complaint was variable. It was relatively shorter in those cases with the lesion at the gingiva or tongue as compared to other locations. The size of the lesion was smaller than 10 x 10 mm. We classified the pathological features into three patterns; granuloma type, hemangioma type, and intermediate type. Many cases of lesions located at the back of the tongue, buccal mucosa, or hard palate were of the hemangioma type, while many cases of lesions located at the top of the tongue, gingiva, or oral floor were of the granuloma type. We have the impression that pyogenic granuloma could be one of the purulent changes associated with benign oral tumors.

Adolescent↗

Pitfalls in the histopathologic diagnosis of pyogenic granuloma.

The term pyogenic granuloma (PG) is a misnomer. The histopathologic appearance is fairly characteristic, the lesion being in fact a lobular capillary hemangioma. The recognition of PG as a clinically polypoid or exophytic, circumscribed lesion is of importance to both the clinician and the pathologist, as this feature distinguishes PG from most malignant vascular tumors. Although PG may be multiple, especially on the skin, and necrosis is not uncommon, invasion of adjacent structures is not seen. Diagnostic pitfalls occur histologically when the characteristic lobular configuration of PG is not recognized because of a solid growth pattern of endothelial proliferation, the presence of brisk mitosis, intervascular stromal fibrosis or spindle cell proliferation, and occasionally an epithelioid appearance of endothelial cells. The different vascular neoplasms that may be confused with PG are discussed, and the clinical and histopathologic features of PG are emphasized.

Angiolymphoid Hyperplasia with Eosinophilia↗

Two pyogenic granulomas arising in an epidermoid cyst.

Two pyogenic granulomas arising from the wall of an epidermoid cyst on the midback of a 62-year-old white man are reported. Histologically, each pyogenic granuloma was a polypoid sessile nodule that showed well-vascularized granulation tissue; edema; a mixed inflammatory infiltrate; an epidermal collarette; and a thinned, variably ulcerated epidermis. Although pyogenic granulomas may develop anywhere on the skin, this appears to be the first report of pyogenic granulomas in an epidermoid cyst.

Epidermal Cyst↗

Intravenous pyogenic granuloma of the hand.

Intravenous pyogenic granuloma is a recently described counterpart of cutaneous pyogenic granuloma. We report the second known case of this entity in the orthopedic and hand surgery literature and describe the characteristic clinical and histologic findings associated with this rare benign tumor.

Adult↗