Extra Gingival Pyogenic Granuloma: Unusual Location for the Usual Lesion.

Pyogenic granuloma (PG) is a benign non-neoplastic mucocutaneous lesion formed in reaction to mild irritation or hormonal changes. Although this fairly common lesion has a striking predilection for the gingiva, it can also be found extra gingivally. The clinical diagnosis of such an uncommon extra gingival PG can be quite challenging as the lesions appear as smooth or lobulated red nodules with easy bleeding, occasionally ulcerated mimicking malignancies. The purpose of this article is to report an unusual case of extra gingival PG occurring on the upper lip. The diagnosis of oral lesions is complex due to distinct appearance of the same lesion and leads the clinician to consider lesions with different diagnostic methods.

A Case of Metastatic Renal Cell Carcinoma Mimicking Granuloma Pyogenicum

Renal cell carcinoma (RCC) is well known for its frequent metastasis and particularly to the lungs, liver, bones and brain, but metastasis to the skin is rare. We report here on a case of metastatic RCC in a 73-year-old man who presented with a 1.5 cm sized, moist, beefy-red and exophytic nodule on the scalp. The lesion had grown rapidly for 2 months and it clinically mimicked granuloma pyogenicum. A skin biopsy revealed a solid mass composed of clear cells with clear cytoplasm and oval hyperchromatic nuclei, and they were arranged in an alveolar pattern. As skin metastasis from renal cell carcinoma signals widespread systemic metastasis and a poor prognosis, clinicians should conduct a careful inspection of the skin of a patient with RCC and they should also have a high index of suspicion for finding a primary internal organ malignancy in the RCC patients who present with a skin lesion.

A Case of Subcutaneous Granuloma Pyogenicum of the Finger during Pregnancy / 대한피부과학회지

Subcutaneous granuloma pyogenicum is a rare variant of granuloma pyogenicum. It is often difficult to diagnose based on its clinical features because it appears as a nonspecific deep nodule lacking the characteristic surface changes such as erosion or ulceration, which are the characteristics of common polypoid granuloma pyogenicum. A 28-year-old primigravida presented at 6 months' gestation with a 8-week history of an enlarging mass on the volar aspect of her left thumb. Histological examination revealed that a well-defined tumor nodule occupying the lower dermis and subcutaneous layer was composed of a proliferation of capillaries arranged in a distinct lobular architecture, which is the hallmark of all variants of granuloma pyogenicum. This case suggests additional evidence of the possible role of female sex hormones in the pathogenesis of subcutaneous granuloma pyogenicum.

A Case of Granuloma Pyogenicum within a Port-wine Stain / 대한피부과학회지

Granuloma pyogenicum (GP) has been reported to be associated with hemangioma and hamartomas, including port-wine stains. GP may rarely occur in association with port-wine stains, either de novo or following trauma such as laser therapy. It has been suggested that the development of GP in a port-wine stain following trauma might be associated with microscopic arteriovenous anastomosis in the port-wine stain. We report a 48 year-old woman with GP arising within port-wine stain following trauma.

A Subcutaneous Granuloma Pyogenicum with Multiple Lesions and Recurrence

Subcutaneous granuloma pyogenicum (SGP) is a rare variant of granuloma pyogenicum. In general, it appears as a single subcutaneous nodule with a slight tenderness. We report herein an unusual case of SGP arising from the left palm of an 11-year-old girl. Two mild-tender bean-sized reddish or flesh colored subcutaneous nodules on the lateral border of the left palm, and medial side of 5th left finger, respectively, were noted on physical examination. Histopathologic examination revealed the findings of lobular capillary hemangioma, characterized by localized proliferation of capillary lined by a single endothelial cell layer. Intralesional injection of triamcinolone acetonide (TA) were performed for the treatment. However two new erythematous nodules developed at another area of the left palm, which disappeared without any treatment.

Multiple Subcutaneous Granuloma Pyogenicum Combined with Cherry Angioma

A 51-year-old man had multiple nonspecific subcutaneous nodules and small red hemorrhagic papules on his trunk. Histopathologically, the subcutaneous nodules were shown to be lobular capillary hemangiomas with edematous stroma throughout the entire subcutaneous fat. Multiple subcutaneous granuloma pyogenicum is a rare variant of granuloma pyogenicum. The addition of cherry angioma in the same patient also makes it a very unusual case.

Pyogenic Granuloma (Granuloma Pyogenicum) with Multiple Satellites

Granuloma pyogenicum is a benign vascular tumor and usually occurs as a single lesion. But in a few instances, the development of multiple satellite lesions has been observed following excision or irritation of the primary lesion. Multiple satellite granuloma pyogenicum is a very rare variant of granuloma pyogenicum and occurs most commonly on the back, chest, or trunk, particularly in the interscapular region during childhood. We report a case of multiple granuloma pyogenicum which occurred on the unusual site of the scalp in a 70-year-old woman. The patient presented with a reddish pedunculated nodule with multiple satellite lesions on the right temporal area. The histopathologic findings of the primary and satellite lesions showed many newly formed capillaries and characteristic epidermal collarettes. The lesions were treated by surgical excision and electrodesiccation.

Factor VIII Related Antigen in Granuloma Pyogenicum / 대한피부과학회지

Using Avidin-Biotin immunoperaxidase method, we investigate the distribution patterns of factor VIII related antigen in various areas of skin lesions of 14 granuloma pyogenicum. and in the skin lesions of 5 capillary hemangioma and 5 normal skin. The results are summarized as follows: 1. Factor VIII related antigen was detected in 9 of 14 cases of granuloma pyogenicum, in 4 of 5 cases of capillary hemangioma, and in 5 of 5 cases of normal skin. 2. In the lesions of granuloma pyogenicum the areas with prominent capillary endothelial cell proliferation had less positivity than the vascular areas. And the areas with relatively large vesels in the lesions of granuloma pyogenicum had similar positivity as capillary hemangioma. 3. The lesions of granuloma pyogenicum and capillary hemangioma had less positivity than the vessels of normal derrnis.

A Case of Subcutaneous Granuloma Pyogenicum / 대한피부과학회지

We report herein a case of subcutaneous granuloma pyogenicum developed on the fourth interdigital space of right foot of 36-year-old housewife. Histopathological findings showed characteristic lobular capillary hemangioma. The subcutaneous nodule had a thick fibrous capsule and were composed of multiple, confluent cellular, angiomatous lobules separated by loose fibrous tissue. Most lobules contained round, oval or angular capillaries, lined by proliferated prominant endothelial cells projecting into the lumina of the vessels. Clinically, the lesion was a tender subcutaneous nodule with macerated surface aind soft corn or traumatic epidermal cyst were considered in the differential diagnoses.

A Clinical and Histopathologic Study on Granuloma Pyogenicum / 대한피부과학회지

We observed the histopathologic findings of 21 biopsed materials those initial clinical impression was suspected as granuloma pyogenicum. Also we compared the cange in the number of mast cells in the lesion of the granuloma pyogenicum with those in the normal appearing skin by Giemsa stain, and the stainability of mucopolysaccharides in the stromal edema of granuloma pyogenicum lesion with that in the normal appearing skin by Alcian blue-PAS stain. The results were as fallows: The various microscopic diagnoses made in 8 cases, which was clinically granuloma pyogenicurn. These 8 cases were granulation tissue(3), subungual exostosis(1), dermatofibrorna(1), sebaceous epithelioma(l), liporna with granulation tissue(1), and malignant melanoma(1). 2. The number of mast cells in the granuloma pyogenicum lesion were increased (p<0.01), especially in the lesion which showed marked capillary endothelial proliferation, and the amount of mucopolysaccharides was increased in the stromal edema of the granuloma pyogenicum lesion.

Four Cases Which were Mis-diagnosed as Granuloma Pyogenicum / 대한피부과학회지

We have experienced 4 cases which were clinically diagncsed as granuloma pyogenicum, but histologically as a malignant melanorna, an eccrine angiomatous hamartoma with granuloma pyogenicum, a subungual exostosis, and a lipoma, with granulation tissue. A granuloma pyogenicum may have clinical resemblances to various benign or malignant lesions. Therefore, any lesion that resembles a granuloma pyogenicum should have this clinical impression confirmed by histologic examination.