Summary
The term pyogenic granuloma (PG) is a misnomer. The histopathologic appearance is fairly characteristic, the lesion being in fact a lobular capillary hemangioma. The recognition of PG as a clinically polypoid or exophytic, circumscribed lesion is of importance to both the clinician and the pathologist, as this feature distinguishes PG from most malignant vascular tumors. Although PG may be multiple, especially on the skin, and necrosis is not uncommon, invasion of adjacent structures is not seen. Diagnostic pitfalls occur histologically when the characteristic lobular configuration of PG is not recognized because of a solid growth pattern of endothelial proliferation, the presence of brisk mitosis, intervascular stromal fibrosis or spindle cell proliferation, and occasionally an epithelioid appearance of endothelial cells. The different vascular neoplasms that may be confused with PG are discussed, and the clinical and histopathologic features of PG are emphasized.
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References
Barnes L, Koss W, Nieland ML (1980) Angiolymphoid hyperplasia with eosinophilia: a disease that may be confused with malignancy. Head Neck Surg 2:425–434
Batsakis JG, Rice DH (1981) The pathology of head and neck tumors, part 9B. Head Neck Surg 3:326–339
Bhaskar SN, Jacoway JR (1966) Pyogenic granuloma — clinical features, incidence, histology and result of treatment: report of 242 cases. J Oral Surg 24:391–398
Blickenstaff RD, Roenigk RK, Peters MS, Goellner JR (1989) Recurrent pyogenic granuloma with satellitosis. J Am Acad Dermatol 21:1214–1244
Carla TG, Filotico RS, Filotico MV (1990) Postoperative spindle cell nodules (PSCN) resembling sarcomas: an atypical granulation tissue or atypical pyognic granuloma with exuberant myofibroblastic component? Pathologica 82:279–286
Compagno J, Hyams VJ (1976) Hemangiopericytoma-like intranasal tumors. A clinicopathologic study of 23 cases. Cancer 66:672–683
Cooper PH, Helwig EB (1979) Intradermal and subcutaneous pyogenic granuloma. Study of 40 cases (abstract) Lab Invest 40:249
Cooper PH, McAllister HA, Helwig EB (1979) Intravenous pyogenic granuloma. A study of 18 cases. Am J Surg Pathol 3:221–228
Eichhorn JH, Dickersin R, Bhan AK, Goodman ML (1990) Sinonasal hemangiopericytoma. A reassessment with electron microscopy, immunohistochemistry, and long-term follow-up. Am J Surg Pathol 14:856–866
Enzinger FM, Weiss SW (1988) Benign tumors and tumorlike conditions of blood vessles. In: Enzinger FM, Weiss SW (eds) Soft tissue tumors, 2nd edn. Mosby, St. Louis, pp 489–532
Enzinger FM, Weiss SW (1988) Hemangioendothelioma: vascular tumors of intermediate malignancy. In: Enzinger FM, Weiss SW (eds) Soft tissue tumors, 2nd edn. Mosby, St. Louis, pp 533–544
Enzinger FM, Weiss SW (1988) Malignant vascular tumors. In: Enzinger FM, Weiss SW (eds) Soft tissue tumors, 2nd edn. Mosby, St. Louis, pp 545–580
Fechner RE, Cooper PH, Mills SE (1981) Pyogenic granuloma of the larynx and trachea. A causal and pathologic misnomer for granulation tissue. Arch Otolaryngol 107:30–32
Ferry AP (1990) Pyogenic granuloma of the eye and ocular adnexa: a study of 100 cases. Trans Am Ophthalmol See 87: 327–343
Fu YS, Perrin KH (1974) Non-epithelial tumors of nasal cavity, paranasal sinuses, and nasopharynx: a clinicopathologic study. I. General features and vascular tumors. Cancer 33: 1275–1288
Holden CA, Spittle MF, Wilson Jones E (1987) Angiosarcoma of face and scalp, prognosis and treatment. Cancer 59:1046–1057
Horten C, Mathers WD, Zimmerman LE (1990) Pyogenic granuloma of the palpebral conjunctiva associated with contact lens wear. Cornea 9:359–361
Kerr DA (1951) Granuloma pyogenicum. Oral Surg 4:158
Leyden JJ, Master GH (1973) Oral cavity pyogenic granuloma. Arch Dermatol 108:226–228
McDonald RH (1956) Granuloma gravidarum. Am J Obstet Gynecol 72:1132
Mills SE, Cooper PH, Fechner RE (1980) Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the nasal mucous membranes. Am J Surg Pathol 4:471–479
Mussalli NG, Hopps RM, Johnson NW (1976) Oral pyogenic granuloma as a complication of pregnancy and the use of hormonal contraceptives. Int J Gynaecol Oncol 14:187–191
Olsen TG, Helwig EB (1985) Angiolymphoid hyperplasia with eosinophilia. A clinicopathologic study of 116 patients. J Am Acad Dermatol 12:781–796
Rosai J, Sumner HW, Kostianovsky M, Perez-Mesa C (1976) Angiosarcoma of the skin. A clinocopathology and fine structural study. Hum Pathol 7:83–103
Tervahartiala B, Ainamo J (1989) The development during pregnancy of pyogenic granulomas superimposed upon a congenital hemangioma: a case report. J Peridontol 60:358–361
Vilmann A, Vilmann P, Vilmann H (1986) Pyogenic granuloma: evaluation of oral conditions. Br J Oral Maxillofac Surg 24:376–382
Warner J, Wilson Jones E (1968) Pyogenic granuloma recurring with multiple satellites. A report of 11 cases. Br J Dermatol 80:218–227
Witt TR, Shah JP, Sternberg SS (1983) Juvenile nasopharyngeal angiofibroma. A 30 year clinical review. Am J Surg 146: 521–525
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The opinions or assertions contained in this article are the private ones of the writers and are not to be construed as official or as reflecting the views of the Department of the Navy, Department of Defense or the U.S. Government.
Correspondence to: S. B. Kapadia
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Kapadia, S.B., Heffner, D.K. Pitfalls in the histopathologic diagnosis of pyogenic granuloma. Eur Arch Otorhinolaryngol 249, 195–200 (1992). https://doi.org/10.1007/BF00178468
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DOI: https://doi.org/10.1007/BF00178468