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

Journal of Evidence Based Medicine and Healthcare

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