Page 61 - The Netter Collection of Medical Illustrations - Integumentary System_ Volume 4 ( PDFDrive )

Plate 2-34 Benign Growths

Pyogenic granuloma of the gingiva may be seen
more frequently during pregnancy. This is
occasionally termed granuloma gravidarum.

PYOGENIC GRANULOMA

Pyogenic granulomas are common benign skin tumors.
They frequently occur after trauma and can be induced
by certain classes of medications. They are also seen in
increased frequency during pregnancy. Pyogenic granu-
lomas are vascular tumors or proliferations of vascular
tissue. They occur in all races, and there is no age or
gender predilection, although they are more commonly Pyogenic granuloma on the thumb with
seen in pregnancy. the characteristic collarette of scale
Clinical Findings: Patients often present with a
bleeding papule or nodule that is beefy red and has a
collarette of scale. Pyogenic granulomas are friable and
bleed easily when manipulated. There is often a preced-
ing history of trauma. The lesions are usually small
(5 mm) papules, but some have been reported to be 1
to 2 cm in diameter. These benign growths can also
occur on the mucosa, and another common but unique
location is in a periungual position. They can be tender
and occasionally can become superinfected. A charac-
teristic finding is the “band-aid” sign. This sign repre-
sents the surrounding skin findings of a contact
dermatitis caused by the frequent use of bandages to
cover the pyogenic granuloma due to its propensity to
bleed, sometimes profusely. Pyogenic granulomas are
more common during pregnancy and can be seen on
the gingival mucosa. The most frequent oral location
of involvement is the gingival mucosa. They rarely
resolve spontaneously. The differential diagnosis is
usually between pyogenic granuloma and other vascular-
appearing tumors including metastatic carcinoma, par-
ticularly renal cell carcinoma, bacillary angiomatosis,
and amelanotic melanoma. Pyogenic granulomas are
almost always removed and the diagnosis is confirmed
by histopathologic evaluation.
Pathogenesis: Pyogenic granulomas are thought to
arise after trauma or secondary to medications and to
be caused by a hyperplastic proliferation of vascular Low power. Multiple lobules of blood vessels High power. Proliferation of capillary vessels is
tissue. Chronic localized trauma can cause the release are seen separated by a thin fibrous connective prominent in the center of the tumor lobules.
of vascular growth factors that may induce the prolif- tissue.
eration. Pyogenic granulomas have not been shown to
have any genetic inheritance pattern and are considered
to be sporadic. The exact mechanism of formation is
not well understood. The fact that they are more com- surrounded by a collarette of hyperplastic epithelium. the lesion. These tumors do have a propensity to recur,
monly seen in pregnancy suggests that certain hor- Multiple capillary loops are found within each of the and occasionally an elliptical excision is required for
monal regulations play a role in the formation of these tumor lobules. Strands of fibrous tissue divide the removal. Application of silver nitrate and laser ablation
tumors. tumor into individual lobules of varying size. Many of with the pulsed dye laser have been used successfully. If
Histology: Pyogenic granulomas are also known as these lesions show evidence of surface ulceration result- the pyogenic granulomas are drug induced, stopping
lobular capillary hemangiomas. This is an excellent ing from thinning of the overlying epidermis. The cells the offending medication is sometimes effective in
descriptive name. The lesion is an exophytic growth involved are bland appearing. resolving them. However, many cases of medication-
that has a lobular configuration to its growth Treatment: Most pyogenic granulomas resolve after induced pyogenic granulomas require some method of
pattern. The tumor is typically well circumscribed and shave removal and curettage with cautery of the base of surgical removal.

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS 47