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Atypical Presentation of Pyogenic Granuloma of the Right Index Finger: A Rare Case Report

Tan LS, Daud MH, Nasirudin N

J Hand Surg Asian Pac Vol, 2018 Dec;23(4):577-580.
PMID: 30428790 DOI: 10.1142/S2424835518720335

Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular lesion of the skin or mucous membrane with rapid growth or repetitive trauma. Rarely seen in adult, its management varies and surgical intervention is usually common. We report a case of pyogenic granuloma of the right index finger in a 46-year-old gentleman who presented with painless swelling of the right index finger after a trivial injury. Wedge biopsy confirmed the diagnosis and excision of the granuloma measuring 3 cm × 3 cm × 2 cm was done with curettage and electrocautery over the base of granuloma. The wound subsequently healed well with good functional and aesthetic outcome.

Matched MeSH terms: Granuloma, Pyogenic/diagnosis*; Granuloma, Pyogenic/surgery
Recurrent gigantic pyogenic granuloma disturbing speech and mastication: a case report and literature review

Ong MA, Chai WL, Ngeow WC

Ann Acad Med Singap, 1998 Mar;27(2):258-61.
PMID: 9663321

A case of gigantic pyogenic granuloma with three recurrences in the lower anterior gingiva is presented. Surgical wide excision of the lesion is the treatment of choice. The tumour must be excised down to the periosteum and the irritants around it removed to avoid recurrence. A contributing factor to the gigantic lesion is hormonal changes during pregnancy. Long-term review for 18 months after the third surgery showed no evidence of recurrence at the surgical site.

Matched MeSH terms: Granuloma, Pyogenic/complications*; Granuloma, Pyogenic/pathology; Granuloma, Pyogenic/surgery
Oral pyogenic granuloma (excluding pregnancy tumour)--a clinical analysis of 304 cases

Zain RB, Khoo SP, Yeo JF

Singapore Dent J, 1995 Jul;20(1):8-10.
PMID: 9582682

A clinical analysis of 304 cases of pyogenic granuloma (excluding pregnancy tumour) were obtained from the clinical evaluations submitted by clinicians while sending specimens for biopsy. The average age of the patients with pyogenic granuloma was 28.9 years with a peak age incidence in the second decade. More female patients were affected and the lesions present mainly in the Chinese. The majority of the lesions were ulcerated and pedunculated. The lesions had a mean diameter of 10.8 mm with a mean lesion duration of 6.0 months. The gingiva was the prevalent site for these lesions with a greater number being located in the maxilla. The recurrence rate was found to be 14.1%.

Matched MeSH terms: Granuloma, Pyogenic/epidemiology*; Granuloma, Pyogenic/pathology
Ulcerated bleeding palisaded encapsulated neuroma of the tongue

Dhanuka S, Rodrigues G, Carnello S

Malays J Pathol, 2019 Aug;41(2):229-232.
PMID: 31427561

INTRODUCTION: Palisaded encapsulated neuroma (PEN) is a benign lesion of Schwann cells and its occurrence in the oral mucosa especially the tongue is very rare.
CASE REPORT: This article describes a case of a 41-year-old male, a chronic smoker with an actively bleeding, ulcerated, solitary, firm lesion on the lateral border of the tongue which had bled thrice before. A differential diagnosis of pyogenic granuloma, haemangioma, fibroma, nerve sheath tumour, salivary gland tumour and malignancy was made and surgically excised. Histopathology of the excised specimen revealed a well-circumscribed lesion with spindle-shaped cells arranged in interlacing fascicles and with the help of immunohistochemical markers confirmed it to be a PEN.
DISCUSSION: To our knowledge, this is the first description of an ulcerated PEN presented with an active bleed.

Matched MeSH terms: Granuloma, Pyogenic
Fulltext Tongue pyogenic granuloma excision by using ultrasonic scissors

Irfan Mohamad, Chentilnathan, Periasamy, Yahia, Dawood

Archives of Orofacial Sciences, 2011;6(2):1-3.
MyJurnal

Pyogenic granuloma is a benign lesion which is commonly found in the oral cavity. It is a reactive inflammatory process of the injured mucosa to trauma. It can appear as a sessile or pedunculated mass with smooth or lobulated surface, which sometimes can mimic malignant lesion. Excision biopsy of the lesion is the confirmatory investigation which also a treatment tool. We report a case of middle-aged lady who had pyogenic granuloma of the tongue, which was safely excised using ultrasonic scissors. This case highlights the new technique of using ultrasonic instruments for excision of benign tongue lesion, with marked reduction of blood loss and operation time.

Matched MeSH terms: Granuloma, Pyogenic
Fulltext Giant pyogenic granuloma gravidarum of the hand

Khan ES, Ariff MS, Eshagroni A, Haflah NHM, Abdullah S, Sapuan J

International Medical Journal Malaysia, 2014;13(2):55-58.
MyJurnal

We describe a case of a giant pyogenic granuloma affecting the left index finger of a 23-year-old pregnant lady requiring surgical excision. Pyogenic granuloma gravidarum is a benign hyperplastic lesion that commonly presents on oral mucosa, typically the gums, in approximately 5% of pregnant women. Skin lesions over the fingers are an unusual site during pregnancy with only a few cases reported in the literature. The lesion was excised and a diagnosis of lobular capillary haemangioma was made based on histopathological evaluation. We delayed surgery until after parturition since recurrence is likely to be lower due to lower levels of circulating oestrogen and progesterone. The prognosis is usually excellent following resection. However, recurrences have been reported regardless of the treatment method.

Matched MeSH terms: Granuloma, Pyogenic
Fulltext Inferior canaliculi punctal granuloma of the lacrimal system: a case report

Nur Aqilah S, Farizal A, Othmaliza O

Journal of Surgical Academia, 2016;6(1):39-42.
MyJurnal

Pyogenic granuloma of the eyes usually occurs after ocular surgery or inflammation related to the eyes, itself. This lesion is commonly related to procedures associated with chalazia, strabismus, or even enucleation. However, the incidence of pyogenic granuloma that arises directly from the lower canaliculi of the nasolacrimal system is rare and not being extensively reported. We report a case of an elderly lady who presented with pyogenic granuloma post EDCR with silicone stenting for left nasolacrimal duct obstruction. She presented with persistent left eye epiphora following procedure. The unusual site for pyogenic granuloma and it occurrence after EDCR raise the possibility that the condition is related to previous procedure and the material being used.

Matched MeSH terms: Granuloma, Pyogenic
Fulltext Severe epistaxis in pregnancy due to nasal pyogenic granuloma: A case report

Mohd Yusof J, Abd Halim A, Wan Hamizan AK

J Taibah Univ Med Sci, 2020 Aug;15(4):334-337.
PMID: 32982639 DOI: 10.1016/j.jtumed.2020.06.007

Mild to severe epistaxis is common in pregnancy and often results from increased vascularity of the nasal mucosa and hormonal changes. Symptoms may occur in the absence of an obvious local cause or any systemic disorder; however, thorough otolaryngological (i.e., "ENT") evaluation is always warranted. Pyogenic granuloma or lobular capillary haemangioma is a benign fibrovascular proliferative tumour that is commonly found on the face, fingers, lips, and nasal mucosa. Pregnancy-induced pyogenic granuloma is not an uncommon entity and may result in torrential epistaxis if untreated. Managing a case of severe epistaxis during pregnancy usually requires multidisciplinary management. The authors present a case of severe epistaxis in pregnancy that necessitated examination of the nasal cavity under general anaesthesia. Intraoperative findings showed a bluish-red mass occupying the patient's right maxillary sinus. Bleeding was arrested and complete haemostasis was achieved. The nasal pyogenic granuloma completely resolved in the post-partum period.

Matched MeSH terms: Granuloma, Pyogenic
Pyogenic Granuloma Formation Following Ahmed Valve Glaucoma Implant

Chendran P, Seng Fai T, Wan Abdul Halim WH, Md Din N

J Glaucoma, 2019 10;28(10):e162-e164.
PMID: 31368915 DOI: 10.1097/IJG.0000000000001334

Ocular pyogenic granuloma is a benign tumor seen after ocular insult secondary to ocular surgeries, trauma or infection. Although benign, intervention is sometimes necessary. Previous authors have reported pyogenic granuloma formation following oculoplastic surgeries. We report a pyogenic granuloma after an Ahmed glaucoma valve implantation. A 65-year-old gentleman presented with right eye redness associated with pain and swelling ~2 months after Ahmed glaucoma valve implantation. Examination found a sessile growth on the tube extruding puss with signs of endophthalmitis. The glaucoma drainage device was explanted and culture results grew Staphylococcus aureus. This article discusses the formation of pyogenic granuloma on a glaucoma drainage device and its management.

Matched MeSH terms: Granuloma, Pyogenic/diagnosis; Granuloma, Pyogenic/drug therapy; Granuloma, Pyogenic/microbiology*
Fulltext Pyogenic granuloma like kaposi sarcoma: Case report and review of literature

Mardiana Abdul Aziz, Effat Omar

Journal of Clinical and Health Sciences, 2020;5(2):66-74.
MyJurnal

Pyogenic granuloma-like Kaposi sarcoma (PGLKS) is an uncommon variant of Kaposi
sarcoma (KS), which mimics benign pyogenic granuloma both clinically and histologically. We
report a case of PGLKS of the toe occurring in a HIV-positive individual. It presented as a 2cm
skin swelling of 2 weeks’ duration which was clinically felt to be a pyogenic granuloma.
Histopathological examination revealed a polypoid atypical vascular lesion with overlying
peripheral epidermal collarette. Spindle cell proliferation typically seen in KS was also
identified, which was positive for human herpesvirus 8 (HHV8) by immunohistochemistry,
confirming the diagnosis of PGLKS. Upon review of the literature, our case is the 29th case of
PGLKS reported to date, and only the sixth in Asian population. Particular attention to
histomorphology, and demonstration of HHV8 in lesional tissue will aid accurate diagnosis of
this rare entity.

Matched MeSH terms: Granuloma, Pyogenic
Fulltext Pyogenic granuloma-like lesion in children: Should we wait?

Chooi LK, Saad AZM, Durairajanayagam S

Indian J Plast Surg, 2017 6 16;50(1):104-106.
PMID: 28615821 DOI: 10.4103/ijps.IJPS_25_17

Malignant melanoma is a potentially lethal cutaneous malignancy. Melanoma in paediatrics is rare as compared to adult melanoma. The clinicopathological characteristics of paediatric melanoma are different from adult melanoma, and the presence of melanoma mimics which occurs frequently in children (Spitz naevi) resulted in diagnosis uncertainty. We reported a 9-year-old girl who presented with a slow-growing, pyogenic granuloma-like lesion which was diagnosed with melanoma. It is important to have a high index of suspicion in paediatric skin lesion that would usually be deemed benign. Early tissue biopsy in a suspicious lesion prevents delayed diagnosis and treatment.

Matched MeSH terms: Granuloma, Pyogenic
Fulltext Profile of patients referred to a specialist oral medicine and oral pathology unit

Suraya Hani Mohd Sinon, Nur Syazwani Che Husin, NurulJannah Yusof

Int J Public Health Res, 2013;3(2):325-333.
MyJurnal

The aim of this study was to determine the profile of patients referred to a specialist oral medicine and oral pathology unit in Kuala Lumpur by reviewing clinical dental records received in Oral Pathology Diagnostic Service (OPDS) in Faculty of Dentistry, UKM from 2001 until 2010. A total of 547 archival biopsy clinical dental records were reviewed and analysed using SPSS version 17.0. Oral and maxillofacial diseases were frequently seen in female (1.3:1), young adults (30.0%) of Malay ethnicity (64.6%). Most of the acquired specimens were from dental specialists (n=451, 84.8%), particularly from oral and maxillofacial surgeons (OMFS) (n=349, 63.8%) compared to general dental practitioners (GDPs) (n=81, 14.8%). Almost all of the biopsy specimens were of soft tissue origin (n=462, 84.4%), derived from lining mucosa (n=197, 36.0%) and were biopsied excisionally (n=325, 59.4%) more often than by incisional biopsy (n=207, 37.8%). A large proportion of the oral and maxillofacial diseases were of reactive (n=188, 34.4%) and inflammatory (n=121, 22.1%) cause. Tumours are mainly benign (n=69, 12.6%) with only small cases are malignant (n=34, 6.2%). The most common histological diagnoses were accounted by mucocele (n=56, 10.2%), pyogenic granuloma (n=47, 8.6%), fibroepithelial polyp (n=38, 6.9%), radicular cyst (n=33, 6.0%) and periapical granuloma (n=29, 5.3%). This study characterizes the clinical profile of patients seen in our oral medicine and oral pathology unit. Present findings can be used as a reference to the clinicians and pathologists in effective patient management and organization in the future.

Matched MeSH terms: Granuloma, Pyogenic
Fulltext A 5-year survey of oral and maxillofacial biopsies in Hospital Kota Bharu and Universti Sains Malaysia, Kelantan: 1994-1998

Ghazali, N., Zain, R.B., Samsudin, A.R., Abdul Rahman, R., Othman, N.H.

Malaysian Dental Journal, 2007;28(2):83-91.
MyJurnal

A review of incident oral and maxillofacial biopsies in Kelantan from January 1994 to December 1998 was carried out to evaluate the scope of pathological lesions managed by the two main oral and maxillofacial units in this state. A total of 357 biopsy reports from incident cases of pathological lesions were reviewed. The biopsies were mainly from intra-oral sites (n=326, 91.3%). Females had more frequent oro-facial lesions compared with males (male:female ratio is 0.8:1). The Bumiputera ethnic group had the most number of biopsies (n=321; 90%). The three most commonly observed histopathological groups were the connective tissue hyperplasia (n=90; 25.2%), epithelial dysplasia and neoplasia (n=68; 19%) and salivary gland cysts/mucocele (n=56; 15.7%). The top five most frequent diagnoses were mucocele (n=56; 15.7%), squamous cell carcinoma (n=45; 12.6%), epulides (n=31; 8.7%), pyogenic granuloma (n=25; 7.0%) and fibroepithelial polyp (n=19; 5.3%). Oro-facial malignancies made up almost one-fifth of all diagnoses and squamous cell carcinoma was the most common sub-type. Lymphomas in the oro-facial region (n=8; 11.4%) were more common than basal cell carcinoma (n=7; 10%) and salivary gland malignancies (n=6; 8.5%). Epithelial jaw cysts consisted of 8.7% (n=31) of all diagnoses, where inflammatory types were more common than the developmental types. Odontogenic tumours consisted of 5.6% (n=20) of all diagnoses and ameloblastoma was the predominant type.

Matched MeSH terms: Granuloma, Pyogenic
The Nasal Hemangioma

Tan SN, Gendeh HS, Gendeh BS, Ramzisham AR

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1683-1686.
PMID: 31763224 DOI: 10.1007/s12070-015-0918-4

Hemangioma is a disease of head and neck commonly, but its presence in the nasal cavity or sinus is rare. It is a form of benign tumour of vascular origin consisting of predominantly blood vessels. It can be categorized into capillary, cavernous and mixed type in accordance to its histopathology features. Retrospectively, we reviewed five cases of nasal hemangioma presenting at University Kebangsaan Malaysia Medical Center (UKMMC) between September 2007 and May 2015. Information on the patients age, gender, ethnicity, clinical symptoms, imaging findings (if available), treatment modalities were collected retrospectively for analysis. Five patients were analysed. Females were more affected than male with ratio of 4:1. All patients presented with unilateral lobular capillary hemangioma of the nasal cavity with 60 % (3/5) of the lesions on the right side and 40 % (2/5) on the left side. The common symptoms at presentation were epitaxis and nasal obstruction (5/5, 100 %), followed by rhinorrhea (3/5, 60 %) and facial pain (1/5, 20 %). All the patients underwent a surgical excision of the hemangioma. The five patients had no recurrence on subsequent follow ups. Computed tomography of paranasal sinuses can be performed to exclude bony erosions. Endoscopic sinus haemangioma excision provide good visualisation and better outcomes. In conclusion, nasal hemangioma should always be differential diagnosis for nasal lesions and surgical excision is still the preferred first line treatment.

Matched MeSH terms: Granuloma, Pyogenic

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