A 22-year-old woman comes in to the clinic for a new growth that has evolved over the past 3 months on her finger (Figure 167-1). It started at the end of her pregnancy and she is now postpartum. The growth is painless, but bleeds easily. She was diagnosed with a probable pyogenic granuloma (PG) and treatment options were discussed. She opted for shave excision, followed by curettage and electrodesiccation (Figure 167-2). The tissue was sent for pathology and confirmed the diagnosis of PG. On follow-up the site was healing well and the patient was very happy with the result.
Pyogenic granuloma on the finger that started in pregnancy.
Pyogenic granuloma treatment. A. Shave excision to be sent for pathology. B. Curettage of the base. C. Electrodesiccation of the base. D. Immediate final result. Note how the stalk was much narrower than the lesion itself. (Reproduced with permission from Richard P. Usatine, MD.)
Pyogenic granuloma (PG) is a relatively common benign acquired vascular growth of the skin and mucous membranes.
PG is also known as lobular capillary hemangioma (LCH) due to its histologic appearance. PG is a misnomer as it is neither pyogenic nor granulomatous. However, it often has a purulent-appearing exudate that explains how it got its name (Figure 167-3).
Pyogenic granuloma that started with trauma from a three-ring binder. Note how it appears purulent, explaining how it got named "pyogenic" despite the fact that it is not a bacterial infection. (Reproduced with permission from Richard P. Usatine, MD.)
Seen most commonly in children, teens, and young adults. Mean onset in children is age 6.7, but can occur throughout childhood. Generally acquired, but 1% are present at birth.1
Oral lesions are more common in women, particularly in the 2nd and 3rd decades of life, and in pregnancy.1
PGs have also rarely been reported in the GI tract, nose, conjunctiva, and subcutaneous and intravenous locations.
ETIOLOGY AND PATHOPHYSIOLOGY
Etiology is unknown. PGs may be associated with prior trauma (see Figure 167-3), wound, and hormonal changes, but a direct relationship has not been proven.
It is hypothesized that pro-angiogenic growth factors play a role in development of PG. This may account for the reported response of pediatric PGs to beta blockers.2
Histopathology demonstrates proliferation of capillaries and venules with neutrophilic infiltrates, in a lobular pattern.3,4