Pyogenic granuloma of the penile shaft following circumcision

Distal penile pyogenic granuloma: A case report

Key Clinical Message

The mainstays of treatment for granuloma pyogenicum include careful evaluation of any penile growth, thorough excision of the polypoid, histological examination, and close monitoring to check relapse and management.

Abstract

Pyogenic granuloma is an acquired noncancerous vascular proliferation that arises from the mucosa and skin, seldom subcutaneously or intravascularly. It is also referred to as telangiectasis granuloma or lobular capillary haemangioma. The risk factors include vascular abnormalities, medicines, hormones, and microtrauma. We discussed the case of a 24-year-old man who had a poorly managed ventral distal penile polypoid lesion at a peripheral hospital. Upon further histopathological examination, the diagnosis of pyogenic granuloma was made. Histopathologically speaking, the term "pyogenic granuloma" is misleading because the illness is not linked to the production of granulomas. Pyogenic granuloma's etiopathogenesis is still unknown; true hemangioma is thought to be a reactive hyperproliferative of the vasculature brought on by a variety of stimuli; pyogenic granuloma may be caused by uneven angiogenic factor production in response to minor local trauma or cutaneous disease. Histopathological analysis and surgical excision are the methods used for diagnosis and treatment. The mainstay of treatment for granuloma pyogenic granuloma includes careful evaluation of any penile growth, thorough excision of the polypoid, histological examination, close follow-up to check for relapse, and early management.

Pediatric Penile Non-Involuting Congenital Hemangioma With an Associated Pyogenic Granuloma: Surgical Management of a Rare Vascular Anomaly

Vascular anomalies include both tumors and malformations. Infantile hemangiomas are the most common benign vascular tumor of infancy that proliferate after birth and eventually involute. By contrast, congenital hemangiomas are formed at birth and are categorized into three groups: rapidly involuting, partially-involuting, and non-involuting congenital hemangiomas (NICH). NICH do not regress and grow with age. Pyogenic granulomas, another acquired vascular tumor, develop over vascular lesions and cause bleeding. Primary treatment options for NICH and pyogenic granulomas are surgical resection. Here, we report a case of a NICH with a co-existing pyogenic granuloma involving the penile shaft and scrotum treated surgically.

Pyogenic Granuloma of the Penis: An Uncommon Lesion with Unusual Presentation

We present the case of a 37-year-old man who presented with a penile lesion that engorged on erection. Ultrasound examination demonstrated vascularity of the lesion and the decision was made to perform a complete excision. Histological analysis confirmed the diagnosis of a pyogenic granuloma of the penis. Follow-up demonstrated no recurrence at 3 months.

Intravascular Lobular Capillary Hemangioma in the Corpus Spongiosum

Lobular capillary hemangioma (LCH) or pyogenic granuloma is a very common benign vascular tumor. However, its etiology still remains unknown. This tumor classically arises from epithelium-lined tissue, such as skin and mucosa, but subcutaneous and intravenous variants have also been described. Intravenous LCH usually arises within the lumen of large caliber veins, but other intravascular examples have been reported in association with vascular malformations, namely port-wine stains and arteriovenous fistulas. A 54-year-old man presented after the sudden appearance of a subcutaneous nodule on his penile coronal sulcus. A partial biopsy disclosed a lesion with typical features of LCH but with the particularity of being located within the dilated vascular spaces of the corpus spongiosum. After the biopsy, the lesion completely regressed. Although no causal factor could be elicited, trauma was a possible trigger considering the site. Additionally, we speculate that perhaps the normal anatomy of the corpus spongiosum may mimic a similar "slow blood flow environment" found in some vascular malformations, thus providing a possible explanation for the unusual location of the lesion in our patient. This case represents, to our knowledge, the first intravascular LCH described in the corpus spongiosum. Awareness of this unusual intravascular variant of LCH is of paramount importance to avoid misdiagnosis and unnecessary treatment, because the lesion may resolve even if incompletely excised, like in this case.

Huge Pyogenic Granuloma of the Penis

Pyogenic granulomas are benign vascular disorders of the skin and mucose membranes, generally developed by trauma and irritation. The lesions are generally small. They are most commonly seen in the skin and oral mucosa and rarely seen on penis. We present the case of a huge pyogenic granuloma on the penis.

Should pyogenic granulomas following burns be excised?

BACKGROUND

Patients with pygenic granuloma following burns (PGB) presents dramatic clinical features which are different from those with classic pyogenic granuloma. This review aims to discuss whether pyogenic granuloma following burns (PGB) need excision or not.

METHODS

Using the PubMed, EMBASE, Cochrane Library and web of science databases. All articles which discussed diagnosis and treatment of pyogenic granuloma following burns with histological results were included from 1978 to 2013. Reports from meetings were not included. Only articles published in English were included.

RESULTS

Twenty one articles excluded from a total of 32 studies. One study was excluded from the 11 descriptive studies because of typical histological results. The rest, 10 studies were case reports. Only one article was published in French, whose abstract was published in French and English. Patients with PGB presented six distinctive clinical features. First, all the patients had burns initially. The second, PGB acutely erupted between 1 and 4 weeks in patients' burned area, which may be infected by bacteria, fungus and virus. The fourth, PGB can be classified into proliferative and shrivelling stages. The fifth, three hisiological characteristics including hyperkeratosis or acanthosis, numerous newly formed proliferative vascular, edematous stroma with infiltration by plasma cells and lymphocytes. Finally, recurrence, 6 out of 16 patients with PGB involuted spontaneously with no recurrence. Three out of 16 patients were conservatively managed with no recurrence, neither patients (5) who had surgery and 2 patients treated with electro coagulation had recurrence.

CONCLUSIONS

PGB lesions are benign based on clinical features and histological examinations. The clinical process of PGB could be divided into proliferative and shrivelling stages. Conservative treatment including wound management and antibiotic could be chosen firstly, especially when large PGBs are on the face or other important area of one's body. When conservative treatment is ineffective, a surgery could be chosen.

Multiple eruptive periungual pyogenic granulomas during anti-CD20 monoclonal antibody therapy for rheumatoid arthritis

BACKGROUND

New targeted therapies have been developed for inflammatory and neoplastic diseases.

MAIN OBSERVATION

We report on a 73-year-old woman who developed multiple eruptive periungual and subungual pyogenic granulomas. Because of severe rheumatoid arthritis the patient was treated with monoclonal anti-CD20 antibodies. Eruptive granuloma pyogenicum developed after the second antibody application and remained more than 8 weeks after targeted therapy was over. New lesions, however, did not appear.

CONCLUSION

Eruptive granuloma pyogenicum of the nail apparatus is a possible new rare adverse effect of targeted therapies. To the best of our knowledge this is the first case in association with anti-CD20 antibody treatment.

Vulvar pyogenic granuloma in a postmenopausal woman: case report and review of the literature

Introduction. Although pyogenic granulomas (PG) are common and benign vascular proliferations of the skin and mucous membranes, they are relatively rare on the vulva. Case Presentation. A 57-year-old G7P7 postmenopausal woman presented with a 3-year history of a foul smell and bleeding lesions in the genital region. A gynecologic examination revealed multiple large papillomatous, pedunculated, and lobulated lesions that were cherry-red and infective in appearance. There was a 2-cm lesion at the upper intersection of the labia majora, a 2-cm lesion on the right labium majus, and a 4-cm lesion on the clitoris. The patient complained of itching, and the lesions were asymptomatic, except for occasional bleeding. All lesions were excised and sent for histopathological examination, which revealed an ulcerated polypoidal structure with extensive proliferation of vascular channels lined by a single layer of endothelium. The histopathological features were consistent with PG. Conclusion. The present case is the first case of multiple pyogenic granulomas on the vulva in a postmenopausal woman.

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.

Multiple pyogenic granuloma of the penis in a four-year-old child: a case report

Pyogenic granulomas are common, acquired, benign vascular lesions of the skin and mucous membranes that can develop both spontaneously and traumatically. We present a unique case of a four-year healthy, uncircumcised boy with multiple pyogenic granuloma on the mucous face of the penis foreskin. Although penile multiple pyogenic granulomas have previously been described in adults, there are no reports of similar problems in children. In this patient, the pathogenesis of the lesions is probably trauma related as reported in the anamnesis. Therapeutic options are discussed.

Clinicopathological and Ultrastructural Study of Multiple Lobular Capillary Hemangioma after Scalding

We herein report 2 cases of multiple lobular capillary hemangiomas after scalding. The patients exhibited papules and nodules on the scalded areas after healing. Histopathological examination of the lesions showed capillary proliferation in the upper dermis with edematous stroma containing inflammatory infiltrates predominantly composed of neutrophils. Biopsy tissue and secretion specimens from lesions of case 1 were cultured for bacteria, and both grew Enterobacter cloacae. Ultrastructural examination revealed features typical of a lobular capillary hemangioma and viral inclusion bodies in the epidermis of case 1. Multiple lobular capillary hemangiomas after scalding are rarely reported. Trauma may play an important role in the development of this rare condition. Accumulation of similar cases and its precise observation is needed to confirm the associations and to establish an etiological link between the disease and the pathogens.

Pyogenic granuloma caused by exposed sternotomy wires

BACKGROUND

This case describes a 75-year-old African American man who developed a pyogenic granuloma on the chest due to trauma induced by exposed sternotomy wires from his coronary bypass procedure.

OBJECTIVE

To describe a previously unreported cause of pyogenic granuloma.

MATERIALS AND METHODS

The pyogenic granuloma was excised and during the procedure, exposed sternotomy wires were uncoiled at the base of the lesion. The sternotomy wires were retightened and reappositioned along the sternum, and the wound was closed primarily.

RESULTS

The pyogenic granuloma has not recurred after 15 months of follow-up.

CONCLUSIONS

Pyogenic granulomas are vascular benign tumors that commonly appear secondary to trauma. The source of the trauma in this case was the exposed sternotomy wires.

[Errors and risks in ambulatory operations: circumcision]

As one of the most frequently performed operations circumcisions can entail not only typical but also rare complications with possibly fatal consequences. The following areas are of particular importance: legal aspects of the operation, indication for an operation, pre-operative information, post-operative surveillance and after-care. The amount of circumcisions carried out in different European countries vary widely. This shows a difference in indication assessment, which may suppose that a number of operations are not necessary.

Pediatric pyogenic granuloma of the glans penis

Pyogenic granulomas are benign vascular proliferations of the skin and mucous membranes. We present a case report of a 13-year-old uncircumcised boy with phimosis and a pyogenic granuloma of the glans penis. The relationship between these lesions, phimosis, smegma, and circumcision is discussed. When the lesion is found in conjunction with phimosis, consideration should be given for circumcision. Close follow-up to rule out recurrence is necessary.