3.2.7 Pyogenic granuloma
Grading & Level of Importance: C
Granuloma pediculatum, Granuloma teleangiectaticum, lobular capillary hemangioma, pseudobotryomycoma, eruptive angioma, proliferating angioma; epulis granulomatosa (gingiva).
Frequent; all ages; M = F; more common in white than in black people .
Misnomer, since this exophytic benign reactive proliferation of small vessels has nothing to do with bacterial “pyogenic” (pus producing) infection, like “botryomycosis”, which again is a misnomer (mostly due to staphylococcal, not fungal infection).
Aetiology & Pathogenesis
Injuries, wounds, hormones (pregnancy) are initiating factors. Nitrogen Monoxyd Synthase (NOS), Fibroblast Growthh Factor (FGF) and Connective Tissue Growth Factor (CTGF) are important pathogenetic factors.
Signs & Symptoms
Friable, bleeding exophytic proliferatiion with collarette by the surrounding epidermis. Occasionally small angiomatous satellites in the vicinity.
Wounds; areas exposed to injuries; extremities, face, tips of the fingers and toes; lips, tongue, gingiva (epulis).
- eruptive pyogenic granuloma
- subcutaneous intravascular pyogenic granuloma
- pyogenic granuloma with satellites
- pyogenic granuloma on lips, gingiva (epulis)
Laboratory & other workups
Not needed; micobiologic swab (see differential diagnoses).
Erosion on the surface with hemorrhagic crust formation; proliferation of newly formed capillaries with many mitoses around a central vessel. Mixed cellular inflammatory infiltrate in the dermis. Collarette of the epidermis.
Spontaneous involution possible; prognosis good following complete removal.
Bleeding; superinfection; recurrence if not completely removed.
Typical clinical feature and history (trauma, pregnancy).
Granulation tissue, amelanotic melanoma, hemangiosarcoma, botryomykosis (bacterial infection), bacillary angiomatosis (Bartonela Henselae-infection i.e. in HIV).
Prevention & Therapy
Avoid injuries. Removal by excision or laser.
Cave: Confusion with malignant melanoma.
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