Lobular capillary hemangioma (pyogenic granuloma) with satellitosis

Pyogenic Granuloma in the Mandibular Anterior Gingiva: A Case Study

The oral cavity is frequently affected by gingival pyogenic granuloma (PG), a benign tumor that is known for its quick growth and tendency to hemorrhage. The clinical presentation, diagnostic procedure, and treatment of a patient with gingival pyogenic granuloma are all detailed in this case study. A female individual aged 25 years in otherwise good condition arrived with a sessile gingival tumor in the anterior mandibular region that was expanding quickly. During dental hygiene procedures, there was intermittent bleeding and discomfort related to the lesion. Based on histology analysis and clinical examination, PG was diagnosed. The course of treatment included surgical excision followed by a histological analysis to ensure total eradication. Appointments for follow-up revealed adequate healing and no indications of recurrence. This case study aims to demonstrate the need for prompt diagnosis, appropriate treatment, and diligent follow-up to effectively manage gingival pyogenic granuloma. Dental professionals can better treat patients and achieve better results with a thorough understanding of this common oral lesion and its management.

Unusual clinical presentation of oral pyogenic granuloma with severe alveolar bone loss: A case report and review of literature

BACKGROUND

Pyogenic granuloma (PG) is a localized, reddish and vascularized hyperplastic lesion of the connective tissue which occurs in the oral cavity. In most cases, the presence of this lesion does not show alveolar bone resorption. The pathology is diagnosed clinically with some caution. However, the diagnosis and treatment are usually corroborated with histopathological evidence.

CASE SUMMARY

Three clinical cases of PG associated with bone loss were described in this study. The three patients presented tumor-like growth which bled on touch, and were associated with local irritant factors. Radiographs showed bone loss. All cases were treated with conservative surgical excision. The scarring was satisfactory, and there was no case of recurrence. The diagnoses were based on clinical findings, and were confirmed histopathologically.

CONCLUSION

The occurrence of oral PG with bone loss is unusual. Therefore, clinical and radiographic evaluations are important for the diagnosis.

Oral pyogenic granuloma: A case report and review of literature

Uvod: Pyogenic granuloma is a common non neoplastic growth in the oral cavity which is hyperplastic in nature. Various theories of etiopathogenesis have been suggested for pyogenic granuloma. It is commonly thought to be a response to various local irritants like calculus, foreign body material etc. It is hemorrhagic and often bleeds on touch. It usually causes local interference. Excisional biopsy is considered the treatment of choice for pyogenic granuloma followed by removal of the local irritants in order to avoid recurrence. This article presents a case of oral pyogenic granuloma in a 54-year-old patient in the gingiva extending up to the palate with a review of literature. Materials and methods: A thorough case history and clinical examination was done. A provisional diagnosis of pyogenic granuloma was given. Excisional biopsy was performed and the lesion was sent for histopathological evaluation. Result: Histopathological examination of the lesion confirmed the clinical diagnosis of pyogenic granuloma. Conclusion: Pyogenic granuloma is non neoplastic in nature and hence a detailed knowledge of this lesion is required in order to identify it in its early stage and to manage it appropriately before it causes any hindrance in normal routine functions.

:

The soft tissues of the oral cavity are constantly subjected to microtrauma due to various factors. The gingiva in particular reacts to these beyond a point resulting in reactive hyperplastic lesions. Amongst these, the pyogenic granuloma and the peripheral ossifying fibroma are the most common clinical entities. Since they have a similar clinical presentation but diverse histomorphologic illustrations, it was advocated that there exists an interrelation between these two reactive fibrous overgrowths. Hence, this paper is intended to abolish the quandary in diagnosing peripheral ossifying fibroma and pyogenic granuloma.

Lobular capillary hemangioma of the trachea - A rare cause of stridor in elderly: A case report with review of literature

Lobular capillary hemangioma is a rare benign lesion found within the tracheobronchial tree. Patients usually present with recurrent hemoptysis, chronic cough, and rarely, with airway obstruction. We present a case of tracheal lobular capillary hemangioma in a 70-year-old man who presented with stridor and chronic cough. Bronchoscopy showed a 2-cm polypoidal lesion below the vocal cords, which was resected with an electrocautery snare using a rigid bronchoscope. Clinicians should be aware of this entity as one of the differentials for stridor. Bronchoscopic excision of the tumor is feasible and is a minimally invasive therapeutic option for management of these tumors.

[Pyogenic granuloma with satellitosis]

A 16-year-old female developed a satellite-like recurrence of a pyogenic granuloma on her thorax 2 weeks after complete excision. Treatment with a pulsed dye laser led to a complete resolution. BRAF and RAS mutations detected in the pyogenic granuloma are considered major driver mutations. Whether these findings are also of importance for the etiopathogenesis of satellitosis is unknown. In our patient, no BRAF or NRAS mutation could be detected.

A Clinical Report of Solitary Gingival Overgrowth in a Young Female Patient

Pyogenic granuloma is a type of inflammatory hyperplasia. The term “inflammatory hyperplasia” is used to describe nodular growths of oral mucosa that histologically contain inflamed fibrous and granulation tissues. It is nonneoplastic. It is predominant in second decade of life in young adult females. Oral pyogenic granuloma is the most common gingival tumor with a striking predilection to gingiva. About one-third of the lesions occur following trauma. Poor oral hygiene may be a precipitating factor as 75% of all cases show calculus or foreign material in gingival sulcus. Lesions are more common in maxillary than mandibular gingiva; lesions are more common on the facial aspect of gingiva than gingival aspect. Clinically, pyogenic granuloma is a smooth, lobulated, exophytic lesion seen as small, red, and erythematous papules on a pedunculated or sessile base that is usually hemorrhagic. Clinical development of the lesion is slow, asymptomatic, and painless but may also grow rapidly; surface is characteristically ulcerated and friable, covered by yellow, fibrinous membrane with its color ranging from pink to red to purple depending on the age of the lesion. Pyogenic granuloma develops in about 5% of pregnancy, called as “pregnancy tumor’’ or “granuloma gravidarum.” Hormonal imbalance in pregnancy exaggerates the body’s response to bacterial irritation. Sometimes, pregnancy gingivitis may show a tendency for localized hyperplasia, which is called “pregnancy granuloma.” Generally, it appears in about second-to-third month of pregnancy. Although pyogenic granuloma is a nonneoplastic growth in the oral cavity, proper diagnosis, prevention, management, and treatment of the lesion is very important. Excisional surgery is the treatment of choice whereas cryosurgery, excision by Nd:YAG laser, and sclerotherapy are alternative therapies. Though pyogenic granuloma in pregnancy is because of the effect of sex hormonal imbalances, taking careful oral hygiene measures is important to avoid recurrence of the lesion. This article is a case report of a 22-year-old female patient with pyogenic granuloma in the buccal aspect of maxillary gingiva managed by surgical excision.

Sclerotherapy for the recurrent granulomatous epulis with pingyangmycin

BACKGROUND

Relapse of granulomatous epulis is common after surgery because of local irritations, hormonal level in vivo, or incomplete resection. Currently, if recurrence occurs, then extraction of the teeth adjacent to the lesion is commonly performed, which may influence the aesthetics or masticatory function. Thus, a more effective and less aggressive treatment method is urgently demanded, particularly for the recurring lesion. This study investigated the effects of the intralesional pingyangmycin (PYM) injections for the recurrent granulomatous epulis and assessed the complications.

MATERIAL AND METHODS

A total of 16 patients with recurrent granulomatous epulis underwent intralesional PYM injections, between July 2010 and June 2014. The effects and complications of the treatment were retrospectively reviewed.

RESULTS

The total number of injections performed was 48 (for all patients). The median number of injections per patient was three (range, two to four). All cases completely recovered with no recurrence and resorption of the alveolar bone after a follow-up of more than 12 months. The complications included slight bleeding, local swelling and pain following injection. All these symptoms resolved 7 to 10 days after the injection.

CONCLUSIONS

In summary, intralesional PYM injections may be a preferred option for recurring granulomatous epulis.

A Large Pregnancy Tumor of Tongue - A Case Report

Pyogenic granuloma is a tissue overgrowth which commonly develops as a response to irritation or trauma which is usually localized. Though gingiva is said to be the common site, it also can occur on lip, tongue and buccal mucosa. Pathogenesis is unclear but trauma, infection and hormonal imbalance are attributed as reasons for occurrence. Histologically this reactive lesion is filled with immature fibroblastic connective tissue, profilerative blood vessels and inflammatory cells. This article presents a case of a large pyogenic granuloma of the tongue which is a rare site for this tumor in a 27 year old woman.

Lobular capillary hemangioma of the tracheobronchial tree: A case report and literature review

RATIONALE

Lobular capillary hemangioma (LCH) of the tracheobronchial tree is a rare benign tumor, whose characteristics and treatments remain relatively unknown.

PATIENT CONCERNS

A 39-year-old man with hemoptysis caused by neoplasm in the bronchus intermedius was admitted to our hospital.

DIAGNOSES

The patient was diagnosed with LCH.

INTERVENTIONS

The lesions were removed with biopsy forceps, and cryotherapy was performed.

OUTCOMES

After follow up for more than 2 years, no recurrence was found.

LESSONS

Airway LCH can be treated by excisional biopsy, cryotherapy, APC, laser, radiotherapy, and surgery. Cryotherapy is worthy of recommendation.

Isolated gingival overgrowths: A review of case series

Clinicians are often intrigued by the varied manifestations of the gingival tissue. Gingival overgrowth is a common clinical finding and most of them represent a reactive hyperplasia as a direct result of plaque-related inflammatory gingival disease. These types of growth generally respond to good plaque control, removal of the causative irritants, and conservative tissue management. This case series highlights three different cases of localized gingival overgrowth and its management with emphasis on the importance of patient awareness and motivation.

Management of a Recurrent Pyogenic Granuloma of the Hard Palate with Diode Laser: A Case Report

INTRODUCTION

Pyogenic granuloma (PG) is a prevalent inflammatory hyperplasia of skin and oral mucosa which is often caused by constant low-grade local irritation, traumatic injury or hormonal factors. In many cases, gingival irritation and inflammation due to poor oral hygiene are precipitating factors. Oral PG occurs predominantly on the gingiva, but it is also encountered on the lips, tongue, buccal mucosa and rarely on the hard palate. Although surgical excision is the first choice of treatment, many other treatment modalities could be counted such as cryosurgery, sodium tetradecyl sulfate sclerotherapy, intralesional steroids, flash lamp pulsed dye laser, neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, carbon dioxide (CO2) laser, erbium-doped yttrium aluminum garnet (Er:YAG) lasers and diode laser have been suggested. After surgical excision recurrence occurs up to 16% of these lesions. It is believed that recurrence ensues as a result of incomplete excision, failure to eliminate etiologic factors or repeated trauma.

CASE REPORT

A 50-year-old female was referred to the Department of Oral Surgery, Gazi University, School of Dentistry, complaining of a swelling and growth on the right side of the hard palate for four months. Patient reported a similar growth in the same area about two years earlier, which had turned out to be a PG by histopathology. The treatment plan included surgical excision of the lesion using diode laser.

RESULTS

The patient reported no pain after the surgery. She was discharged with a prescription of chlorhexidine mouthwash and necessary post-operative instructions. At 7 days follow up visit, immediate recurrence of the lesion was observed, and it was excised by diode laser with 2 mm margins at its clinical periphery, to a depth up to the periosteum, by the same operator. No recurrence or scarring was observed in 14 months follow-up.

CONCLUSION

Although diode laser is a secure and efficient technique for the treatment of intraoral PG, in order to minimize its recurrence, the lesion should be excised with a wider margin down to the periosteum or to the causing agent. Also due to its high recurrence rate, long-term follow-up is recommended.

Alternative Therapeutic Approach in the Treatment of Oral Pyogenic Granuloma

Pyogenic granulomas (PGs) in the oral cavity present as an inflammatory hyperplasia usually caused by trauma, hormonal imbalance, chronic irritation, or as the response to a wide variety of drugs. PGs with atypical presentation and behavior may clinically mimic malignant tumors. Thus, histological examination is required to rule out cancer development. Lesions in the oral cavity have been described to be either an isolated entity or present in multiple forms and with multiple recurrences. Conservative surgical excision is the standard choice of treatment in almost every scenario. However, the severity of the lesions and the affected sites often challenge surgical treatment. In this report, we describe the clinical scenario of a recurrent PG, where surgical excision of the lesion was questioned. As an alternative, we describe a noninvasive approach with lesional steroid injections.

Treatment of pregnancy-associated oral pyogenic granuloma with life-threatening haemorrhage by transarterial embolisation

Background:

Pregnancy-associated pyogenic granuloma (pregnancy tumour) is not uncommon. However, control of severe bleeding associated with the lesion by transarterial embolisation has never been reported.

Case report:

We report the case of a 33-year-old pregnant woman (34 weeks gestation) who presented with a pregnancy-associated pyogenic granuloma of the mandibular gingiva with a life-threatening haemorrhage. The bleeding stopped soon after transarterial micro-embolisation and regressed after one month; thus, no further surgical excision was needed. The patient was free of post-operative wound pain and infection, and there was no recurrence after one year of follow up.

Conclusion:

In general, surgical excision is the first treatment choice for pregnancy tumours. However, it is limited by the risk of marked deformity or incomplete excision when large lesions or difficult surgical areas are encountered. For large tumours, transarterial embolisation may be a safer alternative.

Morphological Changes in a Pyogenic Granuloma of the Esophagus Observed over Three Years

A 78-year-old Japanese man underwent routine esophagogastroduodenoscopy, during which a reddish, flat elevated lesion was observed in the middle third of the esophagus. A bright red area of protrusion appeared in the center of the elevated lesion three months later, and the protruded nodule grew to be a blood blister six months after the initial endoscopy examination. The morphology of the lesion changed from a protruded nodule to a mass with two humps that subsequently returned to a single hump during the three-year observation period. A histological diagnosis of pyogenic granuloma was made based on a biopsy performed at six months. This report illustrates a rare case of an esophageal pyogenic granuloma presenting with a unique endoscopic appearance and morphologic changes. Endoscopic ultrasonography images are also presented.

A rare case of rapidly enlarging tracheal lobular capillary hemangioma presenting as difficult to ventilate acute asthma during pregnancy

Background

Lobular Capillary Hemangioma (LCH) is a benign tumour that is known to be hormone responsive and have a relatively high incidence during pregnancy, the most common site being the gingival surfaces. A tracheal origin for this tumour is extremely rare, with no case reported so far in this patient population, and the only reported clinical presentation of tracheal LCH in the literature is with haemoptysis.

Case presentation

We describe a case of a 23-year-old known asthmatic who presented at 32 weeks gestation with life-threatening respiratory failure resembling acute severe asthma, requiring invasive ventilation which was extremely difficult. This was subsequently found to be due to a large tracheal LCH producing a ball-valve phenomenon and predominantly expiratory airflow limitation similar to acute asthma. The endotracheal tube was advanced past the lesion under bronchoscopic guidance, and urgent Caesarean section performed due to foetal distress. The tumour was subsequently debulked and the trachea stented, facilitated by bi-femoral veno-venous extra-corporeal membrane oxygenation with relatively low dose of heparin.

Conclusion

To our knowledge, this is the first report of a unique presentation and management of largest tracheal LCH so far occurring during pregnancy. Pulmonary and critical care physicians should be aware of this unique differential of refractory asthma, the aggressive nature of this benign tumour due to hormonal influences during pregnancy, and feasibility of using bi-femoral veno-venous extra-corporeal membrane oxygenation with low dose heparin as a rescue, given the high risk of bleeding.

Pyogenic granuloma of the gingiva: A misnomer? - A case report and review of literature

Pyogenic granuloma is a commonly occurring inflammatory hyperplasia of the skin and oral mucosa. It is not associated with pus as its name suggests and histologically it resembles an angiomatous lesion rather than a granulomatous lesion. It is known by a variety of names such as Crocker and Hartzell's disease, granuloma pyogenicum, granuloma pediculatum benignum, benign vascular tumor and during pregnancy as granuloma gravidarum. This tumor like growth is considered to be non-neoplastic in nature and it presents itself in the oral cavity in various clinical and histological forms. Due to its frequent occurrence in the oral cavity, especially the gingiva, this article presents a case report of a large pyogenic granuloma of the gingiva and its management, reviews the literature and discusses why the term "pyogenic granuloma" is a misnomer.

Lobulated capillary haemangioma: a common lesion in an uncommon site

Pyogenic granuloma (PG) is a well-known localised granulation tissue overgrowth. It remains an aetiopathological enigma, with trauma, inflammatory and infectious agents being the suspected causative factors. It is a relatively common benign mucocutaneous lesion occurring intraorally or extraorally and is more common in women in the second decade of their lives than in men. Although it is a common lesion it may present with varying clinical features that sometimes may mimic more serious lesions such as malignancies. The clinical diagnosis of such lesion can be quite challenging. This case report drives attention towards the uncommon location of PG of lobular capillary haemangioma type occurring on anterior palate. Surgical excision of the lesion was planned because of the discomfort attributed to large size of the lesion and hindrance in mastication.

Oral pyogenic granuloma--a review of 215 cases in a South Indian Teaching Hospital, Karnataka, over a period of 20 years

INTRODUCTION

Pyogenic granuloma (PG) is a solitary, benign vascular growth. The precise cause for the development of pyogenic granuloma is unknown. It is believed, however, to be an exuberant tissue response to local irritation or trauma. Up to date, few studies have been carried out among Asians, particularly on the Indian subcontinent.

MATERIALS AND METHODS

Biopsy services were researched from 1989 to 2009. Two hundred-fifteen histologically confirmed PGs were retrieved and retrospectively analyzed for incidence, age, gender, site distribution, clinical presentation and histopathology. These cases were also evaluated for recurrence.

RESULTS AND DISCUSSION

Pyogenic granuloma accounted for 50.35% among reactive lesions in this study with a mean age of 34.27 years and a peak incidence in the third decade of life. PG was more common in females with a greater predilection for the maxillary gingivae (50.23%). Eighteen cases occurred in pregnant women. Clinically, PG occurred more frequently as pedunculated lesions (103). Gingival irritation and inflammation due to poor oral hygiene were the major precipitating factors. Histologically, PG presented a greater number of vascular channels of varied sizes, lined with plump endothelial cells, capillary budding, and chronic inflammatory cells, namely lymphocytes and plasma cells. Recurrence was seen in 14.88% of patients, predominantly in females, especially in the maxillary anterior region.

CONCLUSION

Among the reactive lesions, PG had the highest incidence. The frequency of pyogenic granuloma in the southern part of India was much higher compared to other studies. Additional epidemiological research is required to understand the frequency.

Recurrent exophytic growth on maxillary posterior edentulous alveolar ridge--a diagnostic challenge

Accurate diagnosis of recurrent intra-oral exophytic lesions require a thorough history, meticulous clinical examination and the experience of assessing these lesions, because they are not commonplace. Despite this, instituting the correct diagnosis tests the skills of an oral medicine expert. Therefore, the same is all the more challenging for a general practitioner who may encounter these lesions without any significant experience. The importance of diagnosing such lesions cannot be understated, as they may represent a myriad of conditions ranging from seemingly innocuous benign pathologic processes to much more sinister ones, like oral malignancy; occasionally some of these lesions may manifest atypically. Such atypical presentations may cloud the diagnostic process. Here a case uncharacteristic of the condition it represented is reported with the aim of increasing awareness of the diagnosis of such lesions.

Pyogenic granuloma of unusual size with alveolar resorption in a 75-year-old patient

Pyogenic granuloma is an overzealously proliferative non-neoplastic lesion of connective tissue origin, found commonly in oral cavity and is secondary to chronic low grade local irritation, poor oral hygiene, and hormonal disturbances. The term is misnomer because a lesion is unrelated to infection. It is characterized by excessive and exuberant tissue repair response with varied inflammatory component. Since it is a benign lesion, choice of treatment is surgical excision with removal of underlying cause if any. This article aims at presenting a case of pyogenic granuloma in an extremely old patient which is unusual as it attained a very large size and also has caused mild resorption of underlying alveolar bone of mandible.

Laser: a powerful tool for treatment of pyogenic granuloma

Lasers have opened a new door for the treatment of various disorders. Treatment of soft tissue intraoral mucosal growth by laser has profound effect on the patient acceptability taking the functional and aesthetic factor into consideration. The patient is able to get the outdoor treatment without the phobia of local anaesthetic and is out of the clinic in few minutes in contrast to the traditional method of surgical excision. Very few cases have been reported in literature regarding treatment of mucosal growth by soft tissue lasers. We present a case of recurrent pyogenic granuloma in a patient treated with an alternative approach, that is, diode laser, without the use of anaesthesia, sutures, anti-inflammatory drugs, or analgesics. The diagnosis of this lesion is equally important for correct treatment planning.

[Recurrent pyogenic granuloma]

The appearance of multiple satellite lesions is a rare complication of the treatment of a primary pyogenic granuloma lesion. We report 5 cases of recurrent pyogenic granuloma in patients aged between 4 and 31 years. The lesions resolved spontaneously after 1 to 9 months. Although the diagnosis and treatment of recurrent pyogenic granuloma can be problematic, this condition is benign and frequently self-limiting.

Lobular capillary hemangioma in the soft tissue of the finger: sonographic findings

OBJECTIVE

The purpose of this study was to describe the sonographic findings of pathologically confirmed subcutaneous lobular capillary hemangioma of the finger in six patients.

MATERIALS AND METHODS

The clinical records were reviewed for data, including the patients' age and gender, the clinical presentation, a history of trauma, and the tumor site. The sonographic findings were retrospectively analyzed for the specific location within the superficial tissue, the tumor's size, shape, and margin, the internal echogenicity, the internal echo texture, the presence of calcification, the presence of a hypoechoic rim, and the internal vascularity.

RESULTS

The study group consisted of three men and three women, and the six patients' mean age was 39 years (age range: 13-67 years). All the patients were admitted with a painful nodule or a painless protruding nodule in the finger with easy bleeding on contact. In all cases, there was no history of trauma. The mean size of the tumors was 0.85 cm. All the tumors were ill-defined, oval, subcutaneous nodules without calcifications or any hypoechoic rim. Color Doppler sonography showed marked internal vascularity in both the central and peripheral tumor regions in three cases and scanty vascularity in the peripheral region in three cases.

CONCLUSIONS

Subcutaneous lobular capillary hemangioma should be considered when an ill-defined, oval, vascular subcutaneous nodule without calcifications or a hypoechoic rim is seen in the soft tissue of the finger, especially if this tumor is a painful small nodule or a painless protruding small nodule with easy bleeding on contact.

Occurrence of a pyogenic granuloma in relation to a dental implant

Pyogenic granuloma is an inflammatory vascular hyperplasia often occurring in the oral cavity. It appears in response to various stimuli such as low-grade local irritation, trauma, or female steroid hormones. A 32-year-old man sought care for a tender and bleeding lesion of the left posterior maxillary gingiva. The intraoral examination showed an exophytic ulcerated nodule measuring 1.0 cm, related to a dental implant placed in the upper left second premolar position. Radiographic examination showed an oversized healing cap. A provisional diagnosis of reactive inflammatory hyperplasia was made, and the lesion was excised and submitted for histologic examination. On microscopy, the surgical specimen showed an ulcerated nodule consisting of a delicate connective tissue stroma containing numerous blood vessels with plump endothelial cells, intermingled with abundant polymorphonuclear lymphocytes. A diagnosis of pyogenic granuloma associated with a dental implant was made. In this case it was the result of an inappropriate choice of a healing cap, thus allowing an accumulation of dental plaque and sustained chronic inflammation of the peri-implant tissue. A conservative excision and replacement of the healing cap were sufficient for definitive treatment.

A Case of Lobular Capillary Hemangioma (Pyogenic Granuloma), Localized to the Subcutaneous Tissue, and a Review of the Literature

Lobular capillary hemangioma (pyogenic granuloma) is a common vascular proliferation that typically occurs in the superficial dermis, although rarely a subcutaneous form has been reported. Although these lesions are considered benign, localized recurrence after excision and satellite spread of the lesions are known phenomena. A case of lobular capillary hemangioma with the unusual features of both subcutaneous localization and locally aggressive behavior following surgery in a patient with a history of estrogen use and local trauma prior to the onset of the lesion is presented. The literature of lobular capillary hemangioma is reviewed, and the differential diagnosis is discussed.

Recurrent intraoral pyogenic granuloma with satellitosis treated with corticosteroids

The development of recurrent pyogenic granulomas as multiple satellite lesions has not been reported in the oral cavity. This report describes an unusual case of intraoral pyogenic granuloma recurring multiple times after surgical excisions with the formation of satellite lesions. Due to failure of surgical management, an alternative approach was taken. We illustrate how the lesions were successfully treated with a series of intralesional corticosteroid injections.

Oral pyogenic granuloma: a review

Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury or hormonal factors. It predominantly occurs in the second decade of life in young females, possibly because of the vascular effects of female hormones. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manifesting as small, red erythematous papules on a pedunculated or sometimes sessile base, which is usually hemorrhagic. The surface ranges from pink to red to purple, depending on the age of the lesion. Although excisional surgery is the treatment of choice for it, some other treatment protocols such as the use of Nd:YAG laser, flash lamp pulsed dye laser, cryosurgery, intralesional injection of ethanol or corticosteroid and sodium tetradecyl sulfate sclerotherapy have been proposed. Because of the high frequency of pyogenic granuloma in the oral cavity, especially during pregnancy, and necessity for proper diagnosis and treatment, a complete review of published information and investigations about this lesion, in addition to knowledge about new approaches for its treatment is presented.

Giant recurrent pyogenic granuloma on the face with satellitosis responsive to systemic steroids

Pyogenic granuloma is a common benign skin tumour. However, giant recurrent pyogenic granuloma with satellitosis is relatively rare. We present a 52-year-old man who had recurrent gigantic pyogenic granuloma with satellitosis responsive to systemic steroids. Our case of recurrent pyogenic granuloma is interesting because of its clinical presentation, recurrence following surgical excision and its steroid responsiveness. Systemic steroids may be effective in treating recurrent giant pyogenic granulomas during their high-proliferation phase.

Disseminated lobular capillary haemangioma

A 58-year-old woman presented with a 5-week history of multiple widespread vascular lesions. Histological examination confirmed the clinical diagnosis of disseminated lobular capillary haemangioma. No underlying cause for this eruption could be found. The lesions resolved over the following 2 months without intervention. Reports of disseminated lobular capillary haemangioma are scarce in the literature. In general, this condition does not appear to be related to an underlying disorder and in particular is not a marker for underlying malignancy. No unifying concept as to the aetiology of disseminated lobular capillary haemangioma has been identified. The condition appears to follow a benign course, with spontaneous resolution over 6-12 months.

Targetoid hemosiderotic hemangioma- a dynamic vascular tumor: report of 3 cases with episodic and cyclic changes and comparison with solitary angiokeratomas

BACKGROUND

Both targetoid hemosiderotic hemangiomas (THH) and solitary angiokeratomas (SAK) are acquired vascular malformations formed by superficial vascular ectasias possibly caused by trauma.

OBJECTIVE

We compare the clinicopathologic findings of THHs with those of SAKs and report the clinicopathologic findings of 3 singular cases of THH affected by cyclic or episodic morphologic changes.

METHODS

We performed a clinicopathologic study on 33 cases of THH and compared this group with 20 cases of SAK. On selected cases, histochemical and immunohistochemical analyses were evaluated.

RESULTS

Overlap of all the clinical and pathologic features studied were identified for THH and SAK. Clinically, they both commonly exhibited a brown or black papule located over the lower extremities that mimicked a melanocytic lesion. Histologically, they both had ectatic papillary dermal vessels with overlying epidermal hyperplasia, and adjacent hemosiderin deposits, extravasated red blood cells, lymphocytic infiltrate, and lymphangiectases. Compared with SAKs, THHs were significantly larger (5.3 vs 3.2 mm), more often excised (elliptical excision) than shave or punch biopsied, and had deeper dermal vessel alterations, more frequent dissecting vascular spaces, and more extensive hemosiderin deposits (all P < .01). THHs presenting with episodic changes were significantly larger than those without (11 vs 4.4 mm, P =.001).

CONCLUSION

THHs and SAKs differ in degree, not in type, of clinicopathologic characteristics. This finding suggests that THHs are larger variants of SAKs whose size is the cause of more extensive, prolonged, or recurrent vessel damage. The histologic findings of extravasated red blood cells, hemosiderin, telangiectases, lymphangiectases, and fibrosis implicate trauma in the cause of these acquired vascular malformations.

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.

Lobular capillary hemangioma of the cauda equina. Case report

This 56-year-old woman presented with a 1-year history of low-back pain, sciatica, and paresthesias in the right S-1 dermatome. On examination the patient was shown to have a right-sided Lasegue's sign, normal strength, hypalgesia in the right S-1 dermatome, and a slight diminution of the right Achilles tendon reflex. Magnetic resonance imaging revealed a 2-cm intradural enhancing lesion at the level of the L-4 vertebra. Laminectomy of L3-L5 vertebrae was performed, and intradural exploration disclosed a blueberry-appearing tumor that was surrounded by an intense arachnoiditis and attached to the right S-1 nerve root. A cystic collection of cerebrospinal fluid was seen caudal to the tumor. Complete removal required transection of the adherent nerve root fascicles. Histological analyses indicate that the lesion was a lobular capillary hemangioma, which, to the authors' knowledge, appears to be one of the first recorded examples of such a case.

Cutaneous vascular proliferation. Part II. Hyperplasias and benign neoplasms

This second part of our review about vascular proliferations summarizes the clinicopathologic features of the cutaneous vascular hyperplasias and benign neoplasms. Hyperplasias comprise a heterogeneous group of vascular proliferations that eventually show a tendency to regression. Angiolymphoid hyperplasia with eosinophilia is included within the group of hyperplasias because of its historical denomination and its reactive nature, probably as a consequence of an arteriovenous shunt, although usually the lesions do not regress. Pyogenic granuloma, bacillary angiomatosis, intravascular papillary endothelial hyperplasia, and pseudo-Kaposi's sarcoma qualify as vascular hyperplasias because they regress when the stimulus that initiated them is removed. Benign neoplasms form a large group of hemangiomas with distinctive clinicopathologic characteristics, although some of them are of recent description and may produce diagnostic difficulties. We classified cutaneous benign vascular neoplasms according to their cell lineage of differentiation, for example, endothelial, glomus cell, and pericytic differentiation. Subsequent categories are established according to the size of the involved vessels (capillaries, venules and arterioles, or veins and arteries) or the nature of the proliferating vessels (blood or lymphatic vessels). Capillary and cavernous hemangiomas have been the terms classically used to name the most common variants of benign vascular neoplasms (i.e., infantile hemangiomas), but they are not the most appropriate denominations for these lesions. First, these names are not contrasting terms. Furthermore, most of the socalled "cavernous" hemangiomas are not hemangiomas (neoplasms) at all, but venous malformations. The most important conceptual issue is that, at any point in time, a particular hemangioma has its own histopathologic pattern throughout the depth of the lesion. For these reasons, we classified hemangiomas into superficial and deep categories. Some of the lesions reviewed have been recently described in the literature, and they may histopathologically mimic lesions of Kaposi's sarcoma; these include targetoid hemosiderotic hemangioma, microvenular hemangioma, tufted hemangioma, glomeruloid hemangioma, kaposiform hemangioendothelioma, spindle-cell hemangioendothelioma, and benign lymphangioendothelioma. In each of these lesions, we update and emphasize those clinical and histopathologic features that are helpful for differential diagnosis with lesions of authentic Kaposi's sarcoma in any of its three stages of development (patch, plaque, or nodule).

[Recurrent pyogenic granuloma or Warner and Wilson-Jones syndrome]

BACKGROUND

Recurrent pyogenic granuloma with multiple satellite lesions is a rare and benign condition; its diagnosis may be clinically evoked from a characteristic natural history.

CASE REPORTS

Two 12 year-old boys developed multiple small cutaneous lesions following removal of pyogenic granuloma, at the periphery of the scar. A CO2 laser treatment was decided in one case, and therapeutic abstention in the other one.

CONCLUSION

Our two cases completely fit with the classical features of such a condition that generally clears spontaneously. This syndrome must be known because of its "pseudo-metastatic" clinical features, which may mislead the physician.

Eruptive pyogenic granulomas: a successfully treated patient and review of the literature

Pyogenic granuloma, also known as lobular capillary haemangioma, is a solitary, benign vascular skin tumour. Although a single pyogenic granuloma is common, multiple eruptive pyogenic granulomas are extremely rare. We report the occurrence of multiple, eruptive pyogenic granulomas in a previously healthy 17-year-old girl. Over 200 lesions appeared spontaneously over an 8-month period. Lesions were initially treated with cryotherapy, and then with the pulsed dye laser, resulting in their complete clearance.