Case 1: Normal squamous epithelium is undermined by a proferation of capillaries in arranged in lobular units. Erosion of the surface is evident along the bottom left of the image. Note the prominent inflammatory infiltrate.
A vascular proliferation in the dermis, usually arranged in a lobular pattern, characterizes this lesion.
In the oral cavity, PGs show a striking predilection for the gingiva, which accounts for 75% of oral cavity lesions. The lesion arises in up to 5% of pregnant women, generally in the 2nd or 3rd trimester (Jafarzadeh).
Histologically, PG is composed of granulation tissue arranged in vascular lobules. It is not a granuloma, hence, it is a misnomer. A collarette of epidermis (especially if on the skin) may "clutch" the lesion on either side (Rapini). Erosion or ulceration of the surface is a frequent finding, and the lesion is often friable. Minor trauma may therefore cause bleeding.
It usually presents as a sessile or nodular exophytic mass, which may be pedunculated. It may range in size from a few millimeters to several centimeters. It is usually less than 2.5 cm, and usually reaches maximal size in a few weeks. Growth is usually slow and painless, but cases of rapid growth are also not uncommon.
Usually treated with conservative excision. Since PGs usually arise from some kind of stimulant such as drug or mechanical irritation, removal of the stimulant may also be important in treatment.
Benign, but recurrences do occur. During pregnancy, careful attention to oral hygiene is especially important to try to reduce recurrences.
&rarr:PG can occur on the skin, fingers, mouth or oral cavity. Present as a friable, pedunculated nodule or papule.
→Also called lobular capillary hemangioma; histologically composed of granulation tissue arranged in vascular lobules (not a granuloma, misnomer).
Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review.J Oral Sci. 2006 Dec;48(4):167-75.
Rapini RP. Practical Dermatopathology. Philadelphia, PA: Elsevier; 2005: 324-5.