Colonic pyogenic granuloma in children: a rare or rarely recognized entity

Pyogenic granuloma of the ampulla of Vater: unexpected cause of gastrointestinal bleeding

We describe the case of a previously healthy 8-year-old girl presenting with a 1-year history of iron deficiency anemia. There was no report of hematemesis, abdominal pain or melena. Laboratory work-up excluded iron malabsorption as the underlying cause. Therefore, endoscopic evaluation was performed to exclude gastrointestinal blood loss, which revealed the presence of a 7 mm reddish lesion located within the ampulla of Vater. Capsule endoscopy excluded alternative diagnoses and concomitant lesions. Histopathological examination confirmed the diagnosis of pyogenic granuloma. The young age of the child and the benign nature of this lesion along with the absence of complications favored conservative management. Pyogenic granuloma is a benign vascular lesion that presents as a polypoid red mass. In the gastrointestinal tract, it is a rare condition and occurs more commonly in the elderly. The most common sites are the small intestine, esophagus, and colon, but they can occur throughout the entire gastrointestinal tract with a propensity to bleed that may cause iron deficiency anemia. In pediatric age patients, there are few reports of gastrointestinal pyogenic granulomas, most of which occur in the colon and rectum. Its identification and location in the ampulla of Vater is an exceptional finding.

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.

Pyogenic granuloma of the duodenum treated successfully by endoscopic mucosal resection

Pyogenic granuloma is a lobular capillary hemangioma that occurs mostly on the skin and the mucosal surfaces of the oral cavity and tongue. Only a few cases in other parts of the digestive tract have been reported. Gastrointestinal pyogenic granuloma is a rare cause of hemorrhage in the digestive tract, but should be considered in the differential diagnosis of patients with gastrointestinal bleeding. We report the case of a 62-year-old anemic woman found to have a pyogenic granuloma of the duodenum, which was treated adequately by endoscopic mucosal resection.

Pyogenic granuloma of the sigmoid colon

Pyogenic granuloma (PG) is a polypoid form of lobular capillary hemangioma that usually occurs in the skin and some mucosal surfaces. However, it is extremely rare in the intestinal tract and its preoperative diagnosis is difficult. We report on a case of PG of the sigmoid colon in a 62-year-old woman with a 6-month history of rectal bleeding. A pedunculated polypoid lesion was detected by colonoscopy and a polypectomy was performed. A microscopical study revealed a lobular arrangement proliferation of varying sizes of capillaries within an edematous stroma. A critical review of the English literature yielded only another well-documented case of PG in the large intestine. Diagnostic consideration includes inflammatory polyp and other vascular tumors such as bacillary angiomatosis and the angiomatous variant of Kaposi's sarcoma. Precise recognition of this distinctive vascular neoplasm in the gastrointestinal tract is essential to avoid misdiagnosis and inappropriate treatment.

Pyogenic granuloma-like reaction in the necrotic, vessels-deprived femoral head of the rat

Osteonecrosis of the femoral head was produced in rats by cutting the ligamentum teres and incising the cervical periosteum. As of the second postoperative week, fibrous tissue pervaded the necrotic epiphyses, macrophages and osteoclasts removed the debris, osteoblasts deposited lamellar-fibred and woven-fibred intramembranous bone, and remodeling began. In 16% of the rats killed during the 2nd postoperative week, the epiphyses contained big fragments of necrotic bone enclosed by densely packed, capillary-sized vessels. Ingrowth of this hypervascularized, pyogenic granuloma-like tissue is presumably due to the presence of excessive growth factors, reflecting an exaggerated pathophysiological reaction within the framework of organization of the necrotic epiphyses.