Kembara Xtra - Medicine - Pyogenic Granulomas

Kembara Xtra - Medicine - Pyogenic Granulomas 
Pyogenic granulomas (PG) are benign vascular proliferations that can develop on the skin and mucous membranes. They are also known as lobular capillary hemangiomas. The head and neck, lips and oral cavity, trunk, and extremities are the most often affected areas.
They are smooth, red to purple, sessile or pedunculated, grow rapidly over many weeks, and tend to bleed profusely due to the vascular structure of the lesion.
Rarely totally regress without treatment


Epidemiology PG is most prevalent in children and young people and is frequently detected in the first trimester of pregnancy.

Pathophysiology and Etiology 

Unknown definitive cause; believed to be connected to capillary proliferation brought on by an abnormal healing response to minor trauma; linked to drugs (retinoids, systemic steroids, protease inhibitors, and epidermal growth factor receptor inhibitors); possibly connected to hormonal changes during pregnancy; not a hemangioma or neoplasm; no true granulomatous histology present.

Risk factors include being pregnant, trauma, intraoral surgery, and inflammatory systemic disorders.

Prevention 
A healthy mouth may be beneficial.


Solitary lesion that appears days to weeks after minor damage develops quickly, bleeds easily, grows early in pregnancy, and partially regresses after delivery.


clinical assessment 

The head, neck, and upper extremities are where oral lesions are most frequently found, particularly in youngsters. The gingiva is where oral lesions are most frequently found.
Usually a bright red, friable papule, but it can also be purple, yellow, or brown Surface that is moist and occasionally looks scaly
Usually 1 cm in diameter, but can be as large as 2 to 3 cm in diameter. Giant lesions can occasionally develop on the foot.
On diascopy, red structureless patches are surrounded by a white collarette and are divided by white lines. They are soft; pedunculated or sessile. Solitary red papules grow quickly, producing a stalk. They may bleed and ulcerate.
Erythematous, soft, compressible papule with serosanguinous crusting and distinct demarcation

Benign lesions, cherry/infantile hemangiomas, fibrous papules, and bacillary angiomatosis, all caused by Bartonella, are the differential diagnoses.
Cutaneous metastases, Kaposi sarcoma, Amelanotic melanoma, Basal cell carcinoma, Squamous cell carcinoma, and other malignant tumors

Laboratory Results 

Initial examinations (lab, imaging)
Lab tests are not required for the diagnosis.

Excisional/shave biopsy; send for pathology; other diagnostic procedures.

Interpretation of Tests
Microscopic analysis shows: Immature capillaries with tissue interspersed; Small, endothelial-lined vascular spaces; Loose/dense connective tissue stroma; Acute and chronic inflammatory cells; No true granuloma formation; Abundant mitotic activity.

Management 

To produce material for histopathologic study and prevent recurrence, full thickness surgical excision is preferred (4)[A].
The excision must be sufficient to prevent recurrence. Recurrence may result from even a tiny piece of tissue that was left behind.
Ablation with a CO2 laser causes less discomfort and enables shallow skin ablation.

 Shave biopsy can be combined with cautery and utilized for pedunculated lesions.
Punch biopsy is appropriate for tiny lesions.
Electrosurgery: curettage and electrodesiccation


Surgical Procedures Pulsed dye laser or CO2 laser Topical imiquimod Silver nitrate Liquid nitrogen cryotherapy (recur 2%).

For periungual lesions, a topical 1.5% phenol solution may be utilized.
 Up to 15% of cases recur, depending on the type of treatment.

Constant Care 
Following the excision, the patient should avoid trauma to the region.
Prognosis: Some lesions cure on their own voluntarily (often within 6 months).
Recurrence rates are between 4% and 5% when receiving treatment (2).

Complications 
Recurrence: Several satellite lesions may develop near the original treatment site after a single tumor is removed or destroyed.

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