Pyogenic granuloma is a non-neoplastic tumor growth of the tissues of the oral cavity or skin.
It is the most frequent type of inflammatory hyperplasia of the oral cavity and its histology shows a proliferation of granulation tissue with an inflammatory infiltrate and great angiogenic capacity so there are usually vascular neoformations of different diameters that have an abrupt beginning and end within the tissue.
This lesion, pyogenic granuloma, can be classified into two groups histologically. When the capillaries are arranged in lobules of granulomatous tissue surrounded by a thin band of collagen, the formation is called "capillary lobular hemangioma". When, on the contrary, the vascular formations are intertwined in the tissue without apparent order, it is called "non-globular capillary hemangioma".
The etiology of this type of lesion is not very clear. It is a reactive lesion to various low-grade stimuli, including: repeated trauma, aggressions, hormonal factors and certain drugs. The high incidence of this lesion during pregnancy is related to high estrogen and progesterone levels.
Pyogenic granuloma is basically a proliferation of blood vessels that usually occurs at the site of recent trauma. This pathology almost always affects children and young adults, most often on the skin and less frequently on the mucosa. Typical sites of pyogenic granuloma are the hands, face, hair, trunk and lips.
Most pyogenic granulomas regress spontaneously, although, as they are very bothersome, surgical removal is often considered. The prognosis of pyogenic granuloma of the oral cavity is almost always favorable. Complications often consist of hemorrhages that occur with the slightest trauma. This is another reason why surgical removal is often performed.
Clinically, pyogenic granuloma presents as a fast-growing, soft, pedunculated mass of variable size, reddish color, with a lobulated surface, sometimes ulcerated, and with a great tendency to bleed. When it appears in the mouth, it usually affects the gum and less frequently, it appears on the lips, tongue, oral mucosa and palate. Lesions are more frequent in the upper jaw, anterior and vestibular areas of the gingiva. In some cases, pyogenic granuloma extends to the interproximal area and affects the buccal and lingual side of the gingiva.
Traditionally, the treatment of choice for this type of lesion is complete surgical excision with subperiosteal curettage. To avoid recurrences, it is also necessary to remove possible irritants (plaque, overflowing restorations, etc.).
As we have seen,pyogenic granuloma is the unpredictable response to mild trauma. It is a hyperplastic process characterized by an excessive and reactive cellular multiplication to a traumatic or neoplastic process.
Most lesions usually appear at the site of superficial trauma. The development of pyogenic granuloma is usually very rapid and occurs within a few weeks. Pyogenic granuloma basically presents as a skin lesion smaller or larger than one centimeter in size and red or red-brown in color. The lesion is usually exophytic, i.e. pedunculated and of soft consistency, with a tendency to bleed in case of even minimal trauma.
However, with pyogenic granuloma all areas of the skin and the transitional areas between the skin and mucous membranes, i.e. the lips, nasal mucosa and gums, can be affected. In some cases, pyogenic granuloma also occurs in a nerve or star angioma.
The development and evolution of the injury after trauma is very rapid and occurs within a few weeks.
Pyogenic granuloma presents as a skin lesion:
The lesion is usually painless. The classic sites are:
Outside the oral cavity, they can also appear in:
Probably because these are the sites most frequently subjected to trauma. However, all areas of the skin and the transitional zones between the skin and mucosa (lips, nasal mucosa, gums) may be affected. Pyogenic granuloma sometimes arises over a nevus or a star angioma.
Epulis is a pyogenic granuloma of the oral mucosa, typical of pregnant women, which presents as a pink papule that bleeds easily on the inner surface of the labial mucosa or at the gingival site.
When it comes to pyogenic granuloma, care and treatment vary from case to case. As mentioned, in many cases the best way to remove the pyogenic granuloma is to resort to surgical excision. This should also prevent possible recurrences in the future. However, surgical excision should always be followed by histologic examination to rule out other more serious pathologies, such as ulcerative tumors and amelanotic melanoma.
Alternative treatments for pyogenic granuloma include electrocoagulation, curettage, laser therapy and local application of potent corticosteroid creams in occlusion. Diagnosis of pyogenic granuloma is based on clinical examination, which is possible in most cases. Confirmation should come from histological examination.
Histology reveals a crusty epidermis overlying a vascular proliferation consisting of numerous newly formed capillary vessels arranged around a tooth vessel. If ulceration is present, many neutrophilic granulocytes may also be seen. Pyogenic granuloma should be differentiated by surgical excision and histologic examination from other benign or malignant pathologies such as angioma or nevus of Spitz or Kaposi's sarcoma, a neoplastic proliferation of endothelial cells that constitute the lining of blood vessels and can affect the skin and mucous membranes.
Granuloma refers to the result of a chronic inflammatory reaction typically seen in: infectious diseases, autoimmune diseases, foreign body reactions.
When they occur in pregnant women, they usually grow on the gums and are called "pregnancy tumors". Granulomas can appear immediately after birth, grow in the following years and even disappear completely within a couple of years.
A pyogenic granuloma is usually removed surgically if it recurs after removal by a non-surgical method. Alternatively, the physician may apply a chemical, such as silver nitrate, to the pyogenic granuloma to help the bleeding.
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