3.2.7 Pyogenic granuloma

D23a.57

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).

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.

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)

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).

Avoid injuries. Removal by excision or laser.

Cave: Confusion with malignant melanoma.