Pyogenic Granuloma – A Common Benign Vascular Tumor with Variable Clinical Presentation: New Findings and Treatment Options

Abstract

Pyogenic granuloma is a common benign vascular tumour occurring in all ages. Both skin and mucous membranes can be affected. Of pathogenetic importance are trauma, BRAF mutations and probably herpes virus type 1, Orf virus and/or human papilloma virus type 2. The tumour consists of capillary proliferations, venules and fibromyxoid stroma. The development of a lesion occurs in three stages and bleeding is a common symptom. The tumour can mimic various other vascular lesions, solid tumours, and soft tissue infections. In recent years, targeted tumour therapies have become the most common cause of drug-induced pyogenic granulomas. The backbone of treatment is surgical procedures including laser therapy. New developments in medical drug therapy include topical and systemic beta-adrenergic receptor antagonists timolol and propranolol. Drug therapy is an alternative for young children, ocular and periungual pyogenic granuloma.

Pyogenic Granuloma of the Retina: A Case Series

“…Pyogenic granuloma, also termed lobular capillary hemangioma, is a benign vascular tumor formed by an exaggerated granulation tissue reaction, typically characterized by disorganized capillary growth associated with infiltration of inflammatory cells and increased stromal deposition [7, 8]. This is in contrast with neovascularization, which is composed of a vascular proliferation with minimal if any stroma and minimal if any inflammation.…”

“…This process is also known as pyogenic granuloma, a complication of irritation or breach of the ocular surface by trauma, surgery, or inflammation of the eyelids [5]. Pyogenic granulomas often occur in well-vascularized regions of epithelial or mucosal tissue; ocular pyogenic granulomas tend to present in the conjunctiva, eyelid skin, and rarely on the cornea [6, 7]. Herein, we present 3 cases of granulation tissue formation of the retina resembling pyogenic granulomas which were found in eyes enucleated for endophthalmitis.…”

Therapeutic approaches to pyogenic granuloma: an updated review

“…Pyogenic granuloma (PG) – also known as lobular capillary hemangioma or granuloma teleangiectaticum – is a relatively common vascular proliferation of the skin and mucous membranes but can also occur intravenously, subcutaneously, and in the gastrointestinal tract . It is of benign nature and tends to affect mostly children and adolescents as well as young adults, particularly pregnant women .…”

Effectiveness of topical propranolol 4% gel in the treatment of pyogenic granuloma in children

“…1 The pathogenesis of this common condition remains unknown, but overexpression of growth factors such as vascular endothelial growth factor (VEGF), 2 vascular adhesion molecules such as intercellular adhesion molecule (ICAM)-2 and vascular cell adhesion molecule (VCAM)-1, 3 suggest that it may result from inappropriate activation of pro-angiogenic circuits. 5 Although PG is considered a benign vascular tumor, treatment is often required due to the associated risk of ulceration and bleeding. 4 Several drugs, including oral retinoids, oral contraceptives, epidermal growth factor receptor inhibitors, BRAF inhibitors, mitogen-activated protein kinase inhibitors and rituximab, are associated with PG occurrence and viral infections have also been implicated in the pathogenesis of PG.…”

“…Moreover, mutations in the proto-oncogene BRAF have been identified in PG lesions associated with port-wine stains. 5 However, recurrence is common. 5 Although PG is considered a benign vascular tumor, treatment is often required due to the associated risk of ulceration and bleeding.…”