Abstract:Background
Pyogenic granuloma (PG) is a lesion characterized by the proliferation of blood vessels, commonly affecting the skin and the mouth. We aimed to compare clinical, microscopic, and immunohistochemical features of the two types of oral PG: lobular capillary hemangioma (LCH) and non‐LCH (NLCH).
Methods
Epidemiological and clinical data from 2000 to 2018 were collected from the archives of our institution, and histopathological sections of PG were reviewed. Immunohistochemical analyses (CD34, D2‐40, SMA,… Show more
“…LCH-PG presents specific pathological and immune-histochemical characteristics, characterized by the proliferation of newly formed small vessels, oedema, mixed cell infiltrate, and fibrous septa and collarettes of the adnexal epithelium that partially surround the lesion. As in the case presented here, this distinctive pattern becomes more evident when the epidermis regenerates and when a fibrosis surrounds the capillary tufts [ 1 , 13 , 14 ]. In the present case, immuno-histochemistry was not performed since the endothelial cells could be observed and a definitive diagnosis could be made with only Masson’s trichrome staining.…”
Lobular capillary hemangioma (LCH-PG) is a type of pyogenic granuloma characterized by proliferating blood vessels that resemble conventional granulation tissue. Granulation tissue is very often seen in association with ingrown toenails. Despite the close relationship between both entities, LCH-PG shows clinically different behaviors, such as rapid growth and frequent recurrence. Currently, it is unknown exactly how the different etiological factors contribute to the formation of differences between entities. We present a case of a large LCH-PG associated with chronic onychocryptosis in a 26-year-old man. Histopathological features included extensive signs of ulceration, hyperkeratosis, and patchy epidermal acanthosis with the presence of fibrous septa with lobular areas beneath the ulcerative area. The presence of stroma with a marked proliferation of blood vessels with wall thickening and mixed-type inflammatory changes was also characteristic. In advanced stages of onychocryptosis, as presented here, conventional granulation tissue or pyogenic granuloma can be clinically difficult to distinguish from other benign or malignant neoplasms. Histological examination is mandatory, and excisional biopsy can provide a definitive diagnosis.
“…LCH-PG presents specific pathological and immune-histochemical characteristics, characterized by the proliferation of newly formed small vessels, oedema, mixed cell infiltrate, and fibrous septa and collarettes of the adnexal epithelium that partially surround the lesion. As in the case presented here, this distinctive pattern becomes more evident when the epidermis regenerates and when a fibrosis surrounds the capillary tufts [ 1 , 13 , 14 ]. In the present case, immuno-histochemistry was not performed since the endothelial cells could be observed and a definitive diagnosis could be made with only Masson’s trichrome staining.…”
Lobular capillary hemangioma (LCH-PG) is a type of pyogenic granuloma characterized by proliferating blood vessels that resemble conventional granulation tissue. Granulation tissue is very often seen in association with ingrown toenails. Despite the close relationship between both entities, LCH-PG shows clinically different behaviors, such as rapid growth and frequent recurrence. Currently, it is unknown exactly how the different etiological factors contribute to the formation of differences between entities. We present a case of a large LCH-PG associated with chronic onychocryptosis in a 26-year-old man. Histopathological features included extensive signs of ulceration, hyperkeratosis, and patchy epidermal acanthosis with the presence of fibrous septa with lobular areas beneath the ulcerative area. The presence of stroma with a marked proliferation of blood vessels with wall thickening and mixed-type inflammatory changes was also characteristic. In advanced stages of onychocryptosis, as presented here, conventional granulation tissue or pyogenic granuloma can be clinically difficult to distinguish from other benign or malignant neoplasms. Histological examination is mandatory, and excisional biopsy can provide a definitive diagnosis.
“…Pyogenic granuloma is clinically characterized as a small nodule or papule that arises as a result of an inflammatory reaction, such as local irritation and trauma, which stimulates the development of a highly vascularized granulation reaction. [6][7][8] Previously, it was thought to result from pus-producing microorganisms, leading to the term 'pyogenic'. 9 In the oral cavity, this condition was also responsible for 28% and 50.3% of reactive lesions diagnosed in surveys from Brazil and India, respectively.…”
Section: Discussionmentioning
confidence: 99%
“…4,5 The etiopathogenesis of oral pyogenic granulomas is linked to chronic low-intensity stimuli (such as local irritation and trauma) and, therefore, this lesion is commonly found in individuals with dental calculus and periodontal disease. 6,8 Thus, it is likely that hormonal factors, such as diabetes mellitus, which alter the host's immune response and directly affect periodontal health 3,5 , may interfere with the appearance of more exuberant oral pyogenic granulomas.…”
AimTo discuss the diagnosis and treatment of an exuberant oral pyogenic granuloma (OPG) in the palatal region in a systemically compromised patient.Methods and ResultsA 50‐year‐old woman presented with extensive and painless nodular mass that extended throughout the palatal region, with difficulty speaking, swallowing and spontaneous bleeding for 6 months. Her medical history showed poorly controlled type II diabetes mellitus and hypertension. The intraoral physical examination also revealed poor oral hygiene and periodontal disease. After clinical and radiographic evaluation, the presumptive diagnosis of OPG was made and complete excision of the lesion was performed. Local hemostatic measures were employed to control bleeding. Microscopic evaluation showed a lobulated lesion composed of many blood capillaries confirming the diagnostic hypothesis.ConclusionsIn summary, individuals with severe periodontal disease and systemic disorders may present exacerbated clinical presentations of OPG.
“…This variance suggests that there are two distinct histological types of PG. According to Toida et al [41], some pathogenic factors may have an impact on the development of blood vessels with different luminal sizes in the central region of non-LCH PG and the lobular region of LCH PG.…”
A benign vascular tumor is characterized as a pyogenic granuloma (PG), also referred to as a lobular capillary hemangioma. It develops as a result of cutaneous or mucosal inflammation-induced hyperplasia. Its name is misleading because it neither has anything to do with pus generation nor is it histologically made up of real granulomas. The development of PG's neoplastic tumor is thought to be a response to a variety of stimuli, including prolonged localized inflammation, trauma, hormonal effect, and medications. Poor oral hygiene is thought to be the leading cause of its frequent appearance in the oral cavity. Oral PG affects people of all ages, from 4.5 to 93 years old, however, it most frequently affects women than men in their second and fifth decades of life. After the hard plate, the lips, tongue, buccal mucosa, and gingiva were the most common sites. The frenum, tongue, lips, tongue, and palate were additional locations. It can manifest intraorally in a variety of clinical ways, from a sessile lesion to a raised mass. Techniques used for treating oral PG are many and the choice of the appropriate strategy depends on many factors such as the severity of the case.
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