Abstract
Pyogenic granulomas (PG), also known as lobular capillary hemangiomas based on their histopathologic appearance, are commonly acquired, benign vascular tumor arising in both children and adults (Mills et al, Am J Surg Pathol 4:471–479, 1980). Both names are used synonymously in the literature. PG are classified as a benign vascular tumor (Wassef et al, Pediatrics 136(1):e203–e214, 2015) by the International Society for the Study of Vascular Anomalies (ISSVA). These growths present as rapidly growing, exophytic pedunculated red papules. PG often have an epidermal collarette of scale present as a marker of its rapid growth. They often bleed easily and profusely, ulcerate, and rarely spontaneously regress. PG are found in all ages, commonly occurring in the head and neck in children (Pagliai, Cohen, Pediatr Dermatol 21(1):10–13, 2004). In adults, the most common location is the trunk, with the exception of pregnant women for whom mucosal pyogenic granulomas are more common (Harris et al, J Am Acad Dermatol 42(6):1012–1016, 2000). In both children and adults, there is a slight male predominance (Harris et al, J Am Acad Dermatol 42(6):1012–10, 2000; Pagliai, Cohen, Pediatr Dermatol 21(1):10–13, 2004). PG have rarely been reported in other locations: intravascularly (Cooper et al, Am J Surg Pathol. 3(3):221–228, 1979; Song et al, Int J Dermatol 40(1):57–59, 2001), larynx (Fechner et al, Arch Otolaryngol 107(1):30–32, 1981), intraocular (Ferry, Trans Am Ophthalmol Soc 87:327, 1989), subcutaneous (Fortna et al, Am J Dermatopathol 29(4):408–411, 2007), and within the spinal cord (Andaluz et al, J Neuro-Oncol 56(3):261–264, 2002). Histologically, PG appear as a lobular proliferation of capillaries in the superficial dermis with cytologically bland endothelial cells set in a loose stroma. Immunohistochemical endothelial staining is GLUT-1 negative, distinguishing PG from infantile hemangioma.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Andaluz N, et al. Lobular capillary hemangioma of the spinal cord: case report and review of the literature. J Neuro-Oncol. 2002;56(3):261–4.
Bouscarat F, Bouchard C, Bouhour D. Paronychia and pyogenic granuloma of the great toes in patients treated with indinavir. N Engl J Med. 1998;338(24):1776–7.
Browning JC, et al. Congenital disseminated pyogenic granuloma. Pediatr Dermatol. 2009;26(3):323–7.
Cooper PH, McAllister HA, Helwig EB. Intravenous pyogenic granuloma: a study of 18 cases. Am J Surg Pathol. 1979;3(3):221–8.
Curr N, et al. Multiple periungual pyogenic granulomas following systemic 5‐fluorouracil. Australas J Dermatol. 2006;47(2):130–3.
Devillers C, et al. Subungueal pyogenic granuloma secondary to docetaxel therapy. Clin Exp Dermatol. 2009;34(2):251–2.
Eshkevari SS, Kabir S, Alizadeh N, Nickhaha N. Curettage and punch excision of the vascular base: an effective method for treatment of pyogenic granuloma with excellent results. Iran J Dermatol. 2014;17(69):91–5.
Fallah H, Fischer G, Zagarella S. Pyogenic granuloma in children: treatment with topical imiquimod. Australas J Dermatol. 2007;48(4):217–20.
Fechner RE, Cooper PH, Mills SE. Pyogenic granuloma of the larynx and trachea: a causal and pathologic misnomer for granulation tissue. Arch Otolaryngol. 1981;107(1):30–2.
Ferry AP. Pyogenic granulomas of the eye and ocular adnexa: a study of 100 cases. Trans Am Ophthalmol Soc. 1989;87:327.
Fortna RR, Junkins-Hopkins JM. A case of lobular capillary hemangioma (pyogenic granuloma), localized to the subcutaneous tissue, and a review of the literature. Am J Dermatopathol. 2007;29(4):408–11.
Ghodsi SZ, et al. Comparison of cryotherapy and curettage for the treatment of pyogenic granuloma: a randomized trial. Br J Dermatol. 2006;154(4):671–5.
Godfraind C, Calicchio ML, Kozakewich H. Pyogenic granuloma, an impaired wound healing process, linked to vascular growth driven by FLT4 and the nitric oxide pathway. Mod Pathol. 2013;26(2):247–55.
Groesser L, et al. BRAF and RAS mutations in sporadic and secondary pyogenic granuloma. J Investig Dermatol. 2016;136(2):481–6.
Harris MN, et al. Lobular capillary hemangiomas: an epidemiologic report, with emphasis on cutaneous lesions. J Am Acad Dermatol. 2000;42(6):1012–6.
Holtzman RNN, et al. Lobular capillary hemangioma of the cauda equina: case report. J Neurosurg: Spine. 1999;90(2):239–41.
Keles MK, et al. Multiple subungual pyogenic granulomas following levothyroxine treatment. J Craniofac Surg. 2015;26(6):e476–7.
Kroumpouzos G, Cohen LM. Dermatoses of pregnancy. J Am Acad Dermatol. 2001;45(1):1–22.
Lim YH, et al. Somatic activating RAS mutations cause vascular tumors including pyogenic granuloma. J Invest Dermatol. 2015;135(6):1698.
Malakar S, Malakar RS. Crushing assisted shave excision and electrodessication: a novel approach to treat granuloma pyogenicum. Indian J Dermatol Venereol Leprol. 2000;66(1):29–31.
Majumdar B, Jain A, Bala S, et al. Recurrent pyogenic granuloma with underlying arteriovenous malformation: an exclusively rare entity. Indian J Dermatol. 2015;60(4):423.
Mallet S, et al. Congenital and disseminated pyogenic granuloma-like vascular lesions. Acta Derm Venereol. 2015;95(7):860–1.
Mills SE, Cooper PH, Fechner RE. Lobular capillary hemangioma, the underlying lesion of pyogenic granuloma: a study of 73 cases from the oral and nasal mucous membranes. Am J Surg Pathol. 1980;4:471–9.
Mirshams M, et al. Cryotherapy in the treatment of pyogenic granuloma. J Eur Acad Dermatol Venereol. 2006;20(7):788–90.
***Patrice SJ, Wiss K, Mulliken JB. Pyogenic granuloma (lobular capillary hemangioma): a clinicopathologic study of 178 cases. Pediatr Dermatol. 1991;8(4):267–76.
Patruno C, et al. Periungual and subungual pyogenic granuloma following anti‐TNF‐α therapy: is it the first case? Dermatol Ther. 2013;26(6):493–5.
Piguet V, Borradori L. Pyogenic granuloma‐like lesions during capecitabine therapy. Br J Dermatol. 2002;147(6):1270–2.
Piraccini BM, et al. Periungual and subungual pyogenic granuloma. Br J Dermatol. 2010;163(5):941–53.
Sammut SJ, Tomson N, Corrie P. Pyogenic granuloma as a cutaneous adverse effect of vemurafenib. N Engl J Med. 2014;371(13):1265–7.
Segaert S, Van Cutsem E. Clinical signs, pathophysiology and management of skin toxicity during therapy with epidermal growth factor receptor inhibitors. Ann Oncol. 2005;16(9):1425–33.
Smith SC, et al. Sinonasal lobular capillary hemangioma: a clinicopathologic study of 34 cases characterizing potential for local recurrence. Head Neck Pathol. 2013;7(2):129–34.
Song MG, Kim HJ, Lee ES. Intravenous pyogenic granuloma. Int J Dermatol. 2001;40(1):57–9.
Swerlick R, Cooper P. Pyogenic granuloma (lobular capillary hemangioma) within port-wine stains. J Am Acad Dermatol. 1983;8:627–30.
Sud AR, Tan ST. Pyogenic granuloma–treatment by shave-excision and/or pulsed-dye laser. J Plast Reconstr Aesthet Surg. 2010;63(8):1364–8.
Tritton SM, et al. Pyogenic granuloma in ten children treated with topical imiquimod. Pediatr Dermatol. 2009;26(3):269–72.
*Wassef M, et al. Vascular anomalies classification: recommendations from the International Society for the Study of Vascular Anomalies. Pediatrics. 2015;136(1):e203–14.
**Lee W, Lara, et al. Treatment of pediatric pyogenic granulomas using β‐adrenergic receptor antagonists. Pediatr Dermatol. 2014;31(2):203–7.
**Eshkevari SS, Kabir S, Alizadeh N, Nickhaha N. Curretage and punch excision of the vascular base: an effective method for treatment of pyogenic granuloma with excellent results. Iran J Dermatol. 2014;17(69):91–5.
**Fallah H, Fischer G, Zagarella S. Pyogenic granuloma in children: treatment with topical imiquimod. Australas J Dermatol. 2007;48(4):217–20.
*Ghodsi SZ, et al. Comparison of cryotherapy and curettage for the treatment of pyogenic granuloma: a randomized trial. Br J Dermatol. 2006;154(4):671–5.
*Harris MN, et al. Lobular capillary hemangiomas: an epidemiologic report, with emphasis on cutaneous lesions. J Am Acad Dermatol. 2000;42(6):1012–6.
***Pagliai KA, Cohen BA. Pyogenic granuloma in children. Pediatr Dermatol. 2004;21(1):10–3.
To assist the reader in gaining familiarity with available evidence, the following rating system has been used to indicate key references for each chapter’s content:
***: Critical material. Anyone dealing with this condition should be familiar with this reference.
**: Useful material. Important information that is valuable in in clinical or scientific practice related to this condition.
*: Optional material. For readers with a strong interest in the chapter content or a desire to study it in greater depth.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Khorsand, K., Gupta, D. (2018). Pyogenic Granuloma (Lobular Capillary Hemangioma). In: Perkins, J., Balakrishnan, K. (eds) Evidence-Based Management of Head and Neck Vascular Anomalies. Springer, Cham. https://doi.org/10.1007/978-3-319-92306-2_8
Download citation
DOI: https://doi.org/10.1007/978-3-319-92306-2_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-92305-5
Online ISBN: 978-3-319-92306-2
eBook Packages: MedicineMedicine (R0)