Pyogenic Granuloma (Lobular Capillary Hemangioma)

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.