International Journal of Clinical Case Reports 2016, Vol.6, No.27, 1-3
3
granulomas (Fowler EB, et al., 1996). Factors-like inducible nitric oxide synthase, vascular endothelial growth
factor (VEGF), basic fibroblast growth factor (b-FGF), connective tissue growth factors, involved in angiogenesis,
are considered responsible for the rapid growth of pyogenic granulomas seen in few cases (Hamid Jafarzadeh, et
al., 2006). Pyogenic granulomas are, also, reported to occur after bone marrow transplants (Kanda Y, 2000). The
important differential diagnoses of pyogenic granulomas include peripheral giant cell granulomas, peripheral
ossifying fibromas, peripheral odontogenic tumors, and Kaposi’s sarcoma, and non-Hodgkin’s lymphomas, to add
in the end (Wood NK, and Goaz PW, 1997). Treatment of pyogenic granulomas involves surgical excision along
with the removal of the underlying etiologic factors, if recognizable, with maintenance of a good oral hygiene and
avoidance of trauma to the soft tissues in that area, as it is considered to be, principally, a reactive tumor in nature
(Shafer WG, Hine MK, and Levy BM, 1983). New modalities like cryosurgery, excision by Nd: Yag laser,
injection of absolute alcohol, ethanol or, corticosteroids, sodium tetradecyl sulphate sclerotherapy, can, also, be
used. Topical application of timolol gel has, also, been found to be effective in few cases without side effect as
reported in few studies (Hamid Jafarzadeh, et al., 2006). With surgical excision of pyogenic granulomas, a
recurrence rate, as high as 15%, has been reported. This high recurrence rate observed might be, attributed to
incomplete excision or, failure to remove the underlying etiologic factors of the lesion or, re-injury to the area.
Sometimes, recurrence manifests as Warner-Wilson Jones syndrome, where multiple satellite nodules, surrounding
the original lesion, are seen (Reichart PA, and Philipsen HP, 2000). Also, the recurrence rate of gingival lesions
reported is higher than the lesions from other oral mucosal sites (Sapp JP, Eversole LR, and Wyoscki GP, 1997).
Conclusion
Pyogenic granuloma is a common lesion occurring in oral cavity which frequently occurs on the buccal aspect of
attached gingival tissues. In this case, we came across a highly vascular variant of pyogenic granuloma, named on
histopathological background, as lobular capillary hemangioma that is relatively rare in occurrence. Also, the
lesion was seen as a growth in relation to the palatal aspect of the gingiva. The treatment included surgical
excision of the lesion with flap surgery after a thorough debridement in the affected region. No recurrence was
reported when the patient was followed-up after 1-year of excision, despite being suspected with recurrence, being
a purely vascular lesion.
References
Shafer WG, Hine MK, Levy BM. A Textbook of Oral Pathology. 4th ed., WB Saunders, Philadelphia: 1983; pg.no.s.359-360.
Marks K. Roxburgh's Common Skin Diseases. 17th ed., Arnold, London: 2003; pg.no.197.
Graham RM. Pyogenic granuloma: An unusual presentation. Dental Update 1996;26:2401.
Bjork K, Hoede N, Korting GW, Burgdorf WHC, Young SK. Diseases of the Oral Mucosa and the lips. WB Saunders, Philadelphia: 1996; pg.no.s.229-230.
Hertzell MB. Granuloma pyogenicum. J Cutan Dis Syph 1904;22:520-525.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Surgery.2nd ed., Philadelphia, Saunders: 2002; pg.no.s.447-449.
Epivatianos A, Antoniades D, Zaraboukas T, Zairi E, Poulopoulos A, Kiziridou A, et al.. Pyogenic granuloma of the oral cavity: Comparative study of its
clinico-pathological and immune-histochemical features. Pathol Int 2005;55:391-397.
Mid:15982213
Janier M. Infection and angiomatous cutaneous lesions. J Mal Vasc 1999;24:135-138. PMid:10399647
Fowler EB, Cuenin MF, Thompson SH, Kudryk VL, Billman MA.Pyogenic granuloma associated with guided tissue regeneration: A case report. J Periodontol
1996;67:1011-1015.
Mid:8910841
Hamid Jafarzadeh, Majid Sanatkhani, NooshinMohtasham. Oral pyogenic granuloma: A review. Journal of Oral Science 2006;48:167-175.
Mid:17220613
Kanda Y, Arai C, Chizuka A, Suguro M, Hamaki T, Yamamoto R, et al.. Pyogenic granuloma of the tongue early after allogeneic bone marrow
transplantation for multiple myeloma. Leuk Lymphoma 2000;37:445-449.
Wood NK, Goaz PW. Differential Diagnosis of Oral and Maxillofacial Lesions. 5th ed., Mosby, Missouri: 1997; pg.no.s.549-550.
Reichart PA, Philipsen HP. Color Atlas of Dental Medicine Oral Pathology. Stuttgart, Thieme: 2000; pg.no.s.167-175.
Sapp JP, Eversole LR, Wyoscki GP. Contemporary Oral and Maxillofacial Pathology. 2nd ed., Mosby, Missouri: 1997; pg.no.s.318-322.
