Pyogenic granuloma

Pyogenic granuloma, also referred to as pregnancy tumor, is a primarily oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma. It is often also found to involve the skin and nasal septum. Pyogenic granuloma was first originally described in 1897 by two French surgeons, Poncet and Dor, who named this lesion otyomycosis hominis^[1].

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Due to its overwhelming incidence on the gingiva, the condition is often associated with two other diseases, though not because they occur together. Instead, the three are associated with each other because they appear frequently on gingiva and they also begin with the letter "p" - peripheral giant cell granuloma and peripheral ossifying fibroma. The name for pyogenic granuloma is misleading because it is not a true granuloma. In actuality, it is a capillary hemangioma of lobular subtype which is the reason they are often quite prone to bleeding.

The appearance of pyogenic granuloma is usually a color ranging from red/pink to purple, and can be smooth or lobulated. Younger lesions are more likely to be red because of the high number of blood vessels. Older lesions begin to change into a pink color. Size ranges from a few millimeters to centimeters. Although painless, pyogenic granulomas can bleed easily and grow rapidly.

It is most likely to occur in children and younger adults, and there is a definite gender difference with more females affected than men. In pregnant women, it is most likely to occur in the first trimester with an increasing incidence up until the seventh month and is often seen on the anterior nasal septum as a source of frequent nose bleeds. Pyogenic granulomas appear on the gingiva in 75% of cases, more often in the maxillary than mandibular jaw. Anterior areas are more often affected than posterior areas. It can also be found on the lips, tongue, and inner cheek. Poor oral hygiene or trauma are usually precipitating factors. One study has suggested a correlation between pyogenic granuloma and Bartonella seropositivity.^[2]

The appearance of a pyogenic granulomas microscopically has a highly vascular granulation tissue. Inflammation is present. The lesion may have a fibrous character if it is older, and the surface may have ulcerations.

There is usually no treatment if the pyogenic granuloma occurs during pregnancy since the lesion may heal spontaneously. Recurrent bleeding in either the oral or nasal lesions may necessitate excision and cauterization sooner, however. If aesthetics are a concern, then treatment may be pursued as well. Usually, only conservative surgery may be needed, along with a dental cleaning for oral lesions to remove any calculus or other source of irritation. For nasal lesions, one should be discouraged from any "nose-picking."

Pyogenic granuloma in ophthalmology

Pyogenic granuloma rarely occurs in the conjunctiva, cornea or connective tissue of the eye following minor local trauma. Grossly these mass lesions resemble those occurring at more common sites. Under the microscope, ocular pyogenic granulomata are composed of acutely inflamed, proliferative granulation tissue.^[3] In this sense it may represent an inflammatory psuedotumor. The relationship of this lesion to the lobular capillary hemangioma of skin and oropharyngeal mucosa commonly referred to as pyogenic granuloma is uncertain.

References

1. Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.
2. ^ Ferry AP, Zimmerman LE. Granuloma pyogenicum of limbus. Arch Ophthalmol 74:229-230, 1965.
3. ^ Lee, Joyce and Lynde, Charles. Pyogenic Granuloma: Pyogenic Again? Journal of Cutaneous Medicine and Surgery, vol. 5 no. 6. 2001. Accessed here (SpringerLink), November 29, 2007.
4. ^  Srinivasan S, Prajna NV, Srinivasan M. Pyogenic granuloma of cornea: A case report. Indian J Ophthalmol 1996;44:39-40