Pyogenic Granuloma of the Hard Palate (original) (raw)

Abstract

Pyogenic granuloma (PG) is an inflammatory hyperplasia involving a large range of nodular growths of the oral mucosa. 1,2 In 1844, Hullihen described the first case of pyogenic granuloma. 3 Hartzell in 1904 is credited with giving the current term of "pyogenic granuloma" or "granuloma pyogenicum." It was also called a Crocker and Hartzell's disease. 4 Cawson et al 5 described it as "granuloma telangiectaticum" due to the presence of numerous blood vessels seen in histological sections. Two forms of pyogenic granulomas, the lobular capillary haemangioma (LCH) and the non-lobular capillary haemangioma (non-LCH). 6 Although it is a common disease in the skin, it is rare in the gastrointestinal tract, except for the oral cavity, 7 and it is mostly found in keratinized mucosa. 8 In this article we report an unusual case of extragingival pyogenic granuloma of the hard palate. A 17-year-old male patient with juvenile diabetes mellitus came to ENT OPD of SIMS and presented with a 2 x 2 cm swelling over hard palate that had progressed over 4 months. The lesion was bosselated, raised globular, with regular margins, yielding on touch which confirmed its non-pedunculated nature, was insensitive to pain and didn't bleed on touch, pale reddish in colour. The surface was smooth no ulcerations were seen and was ovoid in shape (Fig 1). The lesion was associated with recurrent bleeding and occasional pain. Based on the lesions' clinical appearance and other characteristics (Slow progression, lack of lymphadenopathy) A provisional diagnosis of minor salivary gland adenoma or capillary hemangioma was made. The differential diagnosis included pyogenic granuloma, peripheral ossifying fibroma, peripheral giant cell granuloma, haemangioma and fibroma. Patient was juvenile diabetic on insulin 12 units morning and 12 units, RBS monitored for a week normal 98 mg/dl before surgery, PPBS; till 140 mg/dl, CBC within normal range, FNAC showed inflammatory cells the mass was excised perorally with a 0.5 cm margin of healthy mucosa and followed by cauterisation of the base. The wound was closed by rotation flaps with 3/0 vicryl suture and specimen send for histopathology (Figure 2). Histopathology showed areas of parakeratinized epithelium and connective tissue

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References (17)

  1. Greenberg MS, Glick M. Burket′s oral medicine: diagnosis and treatment. 10 th edn. BC Decker 2003:130-134.
  2. Eversole LR. Clinical outline of oral pathology: diagnosis and treatment. 3 rd edn. Hamilton: BC Decker 2002:113-114.
  3. Hullihen SP. Case of aneurism by anastomosis of the superior maxillae. Am J Dent Sci 1844;4:160-162.
  4. Hartzell MB. Granuloma pyogenicum. J Cutan Dis Syph 1904;22:520-525.
  5. Cawson RA, Binnie WH, Speight PM, et al. Lucas pathology of tumors of oral tissues. 5 th edn. Missouri: Mosby 1998:252-254.
  6. Akyol MU, Yalciner EG, Dogan AI. Pyogenic granuloma (lobular capillary hemangioma) of the tongue. Int J Pediatr Otorhinolaryngol 2001;58(3):239-241.
  7. Yao T, Nagai E, Utsunomiya T, et al. An intestinal counterpart of pyogenic granuloma of the skin. A newly proposed entity. Am J Surg Pathol 1995;19(9):1054-1060.
  8. Fowler EB, Cuenin MF, Thompson SH, et al. Pyogenic granuloma associated with guided tissue regeneration: a case report. J Periodontology 1996;67(10):1011-1015.
  9. Calonje E, Wilson-Jones E. Vascular tumours: tumours and tumour like conditions of blood, vessels and lymphatics. In: Elder D, Elenitsas R, Jaworsky C, et al, eds. Lever′s histopathology of the skin. 8 th edn. Philadelphia: Lippincott-Raven 1997: P. 895.
  10. Harris MN, Desai R, Chuang TY, et al. Lobular capillary hemangiomas: an epidemiologic report, with emphasis on cutaneous lesions. J Am Acad Dermatol 2000;42(6):1012-1016.
  11. Chen SY, Takeuchi S, Urabe K, et al. Overexpression of phosphorylated-ATF2 and STAT3 in cutaneous angiosarcoma and pyogenic granuloma. J Cutan Pathol 2008;35(8):722-730.
  12. Regezi JA, Sciubba JJ, Jordan RCK. Oral pathology: clinical pathological considerations. 4 th edn. Philadelphia: WB Saunders 2003:115-116.
  13. Nevile BW, Damm DD, Allen CM, et al. Oral and maxillofacial pathology. 2 nd edn. WB Saunders 2004:444-449.
  14. Kamal R, Dahiya P, Puri A. Oral pyogenic granuloma: various concepts of etiopathogenesis. J Oral Maxillofac Pathol 2012;16(1):79-82.
  15. Sato H, Takeda Y, Satoh M. Expression of the endothelial receptor tyrosine kinase Tie2 in lobular capillary hemangioma of the oral mucosa: an immunohistochemical study. J Oral Pathol Med 2002;31(7):432-438.
  16. Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. J Oral Sci 2006;48(4):167-175.
  17. Lee J, Sinno H, Tahiri Y, et al. Treatment options for cutaneous pyogenic granulomas: a review. J Plast Reconstr Aesthet Surg 2011;64(9):1216-1220.