Pyogenic granuloma

Synonyms

Granuloma pediculatum, Granuloma teleangiectaticum, lobular capillary hemangioma, pseudobotryomycoma, eruptive angioma, proliferating angioma; epulis granulomatosa (gingiva).

Epidemiology

Frequent; all ages; M = F; more common in white than in black people .

Definition

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.

Localisation

Wounds; areas exposed to injuries; extremities, face, tips of the fingers and toes; lips, tongue, gingiva (epulis).

Classification

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).

Dermatopathology

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.

Course

Spontaneous involution possible; prognosis good following complete removal.

Complications

Bleeding; superinfection; recurrence if not completely removed.

Diagnosis

Typical clinical feature and history (trauma, pregnancy).

Differential diagnosis

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.

Special

Cave: Confusion with malignant melanoma.

3.2.7 Pyogenic granuloma