International Journal of Clinical Case Reports 2016, Vol.6, No.27, 1-3
2
the said history and clinical features, a provisional diagnosis of pyogenic granuloma was arrived-at while
peripheral giant cell granuloma was considered to be the first differential. Excisional biopsy was carried-out
followed by flap surgery and extraction of 17 was done which was grade III mobile. Suturing was done using 3-0
black silk suture (Fig.3). The excised specimen was sent for histopathological analysis. Histopathologically, H and
E stained section revealed a hyperparakeratotic, stratified squamous epithelium which was discontinuous,
proliferative, with multiple connective tissue entrapments, and with basal cell hyperplasia in some areas.
Underlying connective tissue stroma was fibro-cellular in nature with moderate chronic inflammatory cell
infiltration, chiefly, composed of lymphocytes. Several endothelial-lined blood vessels, some of them, were
dilated and with extravasated RBCs, were seen. Numerous areas showed endothelial cell proliferation (Fig.4). All
these features were consistent with the diagnosis of lobular capillary hemangioma variant of pyogenic granuloma
that is relatively rare in its occurrence.
Fig.1: Profile photograph of the patient
Fig.2: An ovoid, reddish brown growth on the palatal aspect of
maxillary right second premolar and first molar interdentally
Fig.3: Suturing done with 3-0 black silk suture post-excision
and flap surgery with extraction of 17
Fig.4: H and E stained section revealing a hyperparakeratotic,
stratified squamous epithelium with multiple connective
tissue entrapments and with basal cell hyperplasia
Discussion
Pyogenic granuloma can occur at any age although it is more commonly seen during the 2
nd
and 3
rd
decades of life
with no specific racial predilection. It, however, is said to have a definite female predilection with a female to
male ratio for occurrence of 2:1. It was originally thought to be caused by pyogenic microorganisms including
Bartonella quintana, Bartonella henselaea and Human Herpes Virus type 8 which were, also, said to have a role in
the frequent recurrence of the lesion seen, however, there is no confirming evidence regarding the same (Janier M,
1999).
A pre-existing vascular lesion, chronic irritation to the soft tissues by proximal overhangs of the
restorations, fractured restorations and grossly damaged tooth structures, food impaction, chronic periodontitis,
hormonal changes during pregnancy, drugs-like cyclosporine, indinavir sulphate, isotretinoin, oral contraceptive
pills are all considered to be the important pre-disposing, if not, etiologic factors for the lesion. Iatrogenic factors
like Guided Tissue Regeneration (GTR) using Decalcified Freeze-Dried, Bone Allografts (DFDBAs) with
expanded poly-tetra-fluoro-ethylene membranes, have, also, been seen to lead to the occurrence of pyogenic
