Pyogenic granuloma
Encyclopedia
Pyogenic granuloma is a primarily oral disease which appears as an overgrowth
of tissue due to irritation
, physical trauma
or hormonal factors. It is often found to involve the skin and nasal septum
, and has also been found far from the head such as in the thigh.
The name for pyogenic granuloma is misleading because it is not a true granuloma
. In actuality, it is a capillary hemangioma
of lobular subtype which is the reason they are often quite prone to bleeding.
It is also not truly "pyogenic," as the origin is traumatic and not infectious.
ranging from red/pink to purple, and can be smooth or lobulated. Younger lesions are more likely to be red because of the high number of blood vessels. Older lesions begin to change into a pink color. Size ranges from a few millimeters to centimeters. It can be painful, especially if located in an area of the body where it is constantly disturbed. Pyogenic granulomas can grow rapidly and will often bleed profusely with little or no trauma.
It is most likely to occur in children and younger adults, and there is a definite gender
difference with more female
s affected than men. In pregnant
women, it is most likely to occur in the first trimester with an increasing incidence up until the seventh month and is often seen on the anterior nasal septum as a source of frequent nose bleeds. Pyogenic granulomas appear on the gingiva in 75% of cases, more often in the maxilla
ry than mandibular jaw. Anterior areas are more often affected than posterior areas. It can also be found on the lip
s, tongue
, and inner cheek
. Poor oral hygiene
or trauma are usually precipitating factors.
One study has suggested a correlation between pyogenic granuloma and Bartonella
seropositivity. However, this association has been questioned by others. The appearance of a pyogenic granulomas microscopically
has a highly vascular granulation tissue. Inflammation
is present. The lesion may have a fibrous character if it is older, and the surface may have ulcerations. Pyogenic granuloma rarely occurs in the conjunctiva, cornea or connective tissue of the eye following minor local trauma. Grossly these mass lesions resemble those occurring at more common sites. The relationship of this lesion to the lobular capillary hemangioma of skin and oropharyngeal mucosa commonly referred to as pyogenic granuloma is uncertain.
, the condition is often associated with two other disease
s, though not because they occur together. Instead, the three are associated with each other because they appear frequently on gingiva - peripheral giant cell granuloma
and peripheral ossifying fibroma
. However, detailed analysis can be used to distinguish these conditions.
The appearance can be very similar to that of a hemangioma
but unlike henangiomas they can appear after birth.
may be needed, along with a dental cleaning for oral lesions to remove any calculus
or other source of irritation. For nasal lesions, one should be discouraged from any nose-picking.
Hyperplasia
Hyperplasia means increase in number of cells/proliferation of cells. It may result in the gross enlargement of an organ and the term is sometimes mixed with benign neoplasia/ benign tumor....
of tissue due to irritation
Irritation
Irritation or exacerbation, in biology and physiology, is a state of inflammation or painful reaction to allergy or cell-lining damage. A stimulus or agent which induces the state of irritation is an irritant...
, physical trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
or hormonal factors. It is often found to involve the skin and nasal septum
Nasal septum
The nasal septum separates the left and right airways in the nose, dividing the two nostrils.It is depressed by the Depressor septi nasi muscle.-Composition:The fleshy external end of the nasal septum is sometimes also called columella....
, and has also been found far from the head such as in the thigh.
History and terminology
Pyogenic granuloma was first described in 1897 by two French surgeons, Poncet and Dor, who named this lesion botryomycosis hominis.The name for pyogenic granuloma is misleading because it is not a true granuloma
Granuloma
Granuloma is a medical term for a tiny collection of immune cells known as macrophages. Granulomas form when the immune system attempts to wall off substances that it perceives as foreign but is unable to eliminate. Such substances include infectious organisms such as bacteria and fungi as well as...
. In actuality, it is a capillary hemangioma
Capillary hemangioma
A capillary hemangioma appears as a raised, red, lumpy area of flesh anywhere on the body, though 83% occur on the head or neck area. These marks occur in about 10% of all births, and usually appear between one and four weeks after birth. It may grow rapidly, before stopping and slowly fading...
of lobular subtype which is the reason they are often quite prone to bleeding.
It is also not truly "pyogenic," as the origin is traumatic and not infectious.
Clinical presentation
The appearance of pyogenic granuloma is usually a colorColor
Color or colour is the visual perceptual property corresponding in humans to the categories called red, green, blue and others. Color derives from the spectrum of light interacting in the eye with the spectral sensitivities of the light receptors...
ranging from red/pink to purple, and can be smooth or lobulated. Younger lesions are more likely to be red because of the high number of blood vessels. Older lesions begin to change into a pink color. Size ranges from a few millimeters to centimeters. It can be painful, especially if located in an area of the body where it is constantly disturbed. Pyogenic granulomas can grow rapidly and will often bleed profusely with little or no trauma.
It is most likely to occur in children and younger adults, and there is a definite gender
Gender
Gender is a range of characteristics used to distinguish between males and females, particularly in the cases of men and women and the masculine and feminine attributes assigned to them. Depending on the context, the discriminating characteristics vary from sex to social role to gender identity...
difference with more female
Female
Female is the sex of an organism, or a part of an organism, which produces non-mobile ova .- Defining characteristics :The ova are defined as the larger gametes in a heterogamous reproduction system, while the smaller, usually motile gamete, the spermatozoon, is produced by the male...
s affected than men. In pregnant
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
women, it is most likely to occur in the first trimester with an increasing incidence up until the seventh month and is often seen on the anterior nasal septum as a source of frequent nose bleeds. Pyogenic granulomas appear on the gingiva in 75% of cases, more often in the maxilla
Maxilla
The maxilla is a fusion of two bones along the palatal fissure that form the upper jaw. This is similar to the mandible , which is also a fusion of two halves at the mental symphysis. Sometimes The maxilla (plural: maxillae) is a fusion of two bones along the palatal fissure that form the upper...
ry than mandibular jaw. Anterior areas are more often affected than posterior areas. It can also be found on the lip
Lip
Lips are a visible body part at the mouth of humans and many animals. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech...
s, tongue
Tongue
The tongue is a muscular hydrostat on the floors of the mouths of most vertebrates which manipulates food for mastication. It is the primary organ of taste , as much of the upper surface of the tongue is covered in papillae and taste buds. It is sensitive and kept moist by saliva, and is richly...
, and inner cheek
Cheek
Cheeks constitute the area of the face below the eyes and between the nose and the left or right ear. They may also be referred to as jowls. "Buccal" means relating to the cheek. In humans, the region is innervated by the buccal nerve...
. Poor oral hygiene
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...
or trauma are usually precipitating factors.
One study has suggested a correlation between pyogenic granuloma and Bartonella
Bartonella
Bartonella is a genus of Gram-negative bacteria. Facultative intracellular parasites, Bartonella species can infect healthy people but are considered especially important as opportunistic pathogens. Bartonella are transmitted by insect vectors such as ticks, fleas, sand flies and mosquitoes...
seropositivity. However, this association has been questioned by others. The appearance of a pyogenic granulomas microscopically
Microscope
A microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...
has a highly vascular granulation tissue. Inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
is present. The lesion may have a fibrous character if it is older, and the surface may have ulcerations. Pyogenic granuloma rarely occurs in the conjunctiva, cornea or connective tissue of the eye following minor local trauma. Grossly these mass lesions resemble those occurring at more common sites. The relationship of this lesion to the lobular capillary hemangioma of skin and oropharyngeal mucosa commonly referred to as pyogenic granuloma is uncertain.
Associated conditions
Due to its overwhelming incidence on the gingivaGingiva
The gingiva , or gums, consists of the mucosal tissue that lies over the mandible and maxilla inside the mouth.-General description:...
, the condition is often associated with two other disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
s, though not because they occur together. Instead, the three are associated with each other because they appear frequently on gingiva - peripheral giant cell granuloma
Peripheral giant cell granuloma
Peripheral giant-cell granuloma is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, though not because they occur together...
and peripheral ossifying fibroma
Peripheral ossifying fibroma
Ossifying fibroma or peripheral ossifying fibroma is an oral pathologic condition that appears in the mouth as an overgrowth of gingival tissue due to irritation or trauma. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, though not because...
. However, detailed analysis can be used to distinguish these conditions.
The appearance can be very similar to that of a hemangioma
Hemangioma
A hemangioma of infancy is a benign self-involuting tumor of endothelial cells, the cells that line blood vessels. It usually appears during the first weeks of life and sometimes resolves by age 10. In more severe case hemangioma may have permanency, if not treated by a physician...
but unlike henangiomas they can appear after birth.
Treatment
There is usually no treatment if the pyogenic granuloma occurs during pregnancy since the lesion may heal spontaneously. Recurrent bleeding in either the oral or nasal lesions may necessitate excision and cauterization sooner, however. If aesthetics are a concern, then treatment may be pursued as well. Usually, only conservative surgerySurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
may be needed, along with a dental cleaning for oral lesions to remove any calculus
Calculus (dental)
In dentistry, calculus or tartar is a form of hardened dental plaque. It is caused by the continual accumulation of minerals from saliva on plaque on the teeth...
or other source of irritation. For nasal lesions, one should be discouraged from any nose-picking.