Oral Pyogenic Granuloma at Different Spots: A Series of Case Reports

ABSTRACT

Pyogenic granuloma is an inflammatory non-neoplastic lesion of the oral cavity. Chronic, mild, local irritation, trauma, hormonal variables, and certain medications are typical causes of pyogenic granulomas. Women have a higher prevalence than men. The risk is greatest in the second to fifth decades of life. Clinically, the lesion appears smooth, with soft to firm consistency and nontender with a pedunculated or sessile base. Various modalities have been proposed for the treatment of lesion, which include the conventional approach, the use of laser, cryotherapy, and electrocauterization. This case series discusses three cases of pyogenic granuloma in female patients at different locations in the oral cavity. The lesion was subsequently treated with electrosurgery and surgical convention methods. No recurrence of the lesion has been seen in either of the cases.

INTRODUCTION

Soft-tissue enlargements in the oral cavity may be produced by a broad variety of pathologic diseases, including aberrations in normal anatomical structures, inflammation, cysts, developmental problems, and cancer, all of which can make accurate diagnosis challenging. One kind of these lesions is called reactive hyperplasias, and it occurs when an overly enthusiastic or excessive healing response is mounted in response to chronic tissue injury. One of the causes of such soft-tissue hypertrophy is pyogenic granuloma.[1] Oral pyogenic granuloma’s histopathologic profile (hemangioma-like) and inflammatory nature (granuloma) are both reflected in the term “hemangiomatous granuloma,” which was coined by Angelopoulos AP. Since the lesion does not contain pus and is not strictly a granuloma, the term “pyogenic granuloma” is a misnomer.[1] Previously, it was thought to arise from the activity of pyogenic organisms; however, this is now thought to be unrelated to infection. Such reactive tumor-like lesions may be caused by a wide variety of stimuli, including long-term, low-level local irritation, trauma, hormonal changes, and some medication.[2] Its prevalence in the mouth is mostly attributed to a lack of proper oral hygiene. Clinically, it manifests as a small, pinkish soft-tissue mass with a pedunculated or sessile base, ranging from a few millimeters to a few centimeters in size, which is typically painless but may bleed sometimes.

This article discusses a series of cases of pyogenic granuloma at different locations in the oral cavity.

CASE SERIES

Case 1

After experiencing swelling on her hard palate for two months, a 29-year-old woman visited our dental college. The asymptomatic growth started at the palatal contour and progressed into the interproximal buccal area during 15 days. On clinical examination, a single, exophytic, pedunculated, spherical, reddish-pink swelling with clear boundaries and uneven surface measuring approx. 8 mm by 13 mm on the hard palate just behind the central incisors was seen. The swelling was not painful to the touch, and its texture ranged from soft to hard, with minimal bleeding. Orthopantomogram revealed no evidence of bone loss around the lesion. There was no relevant information in the patient’s medical history.

The patient’s hemogram was normal; thus, she was taken for an excisional biopsy under local anesthesia. Electrosurgery was used to completely remove the lesion. The surgical site was dressed with a periodontal dressing, and the patient was given postoperative care instructions. It was recommended that patients take analgesics and antibiotics for a full 5 days after surgery. The removed tissue underwent standard histological assessment after being fixed in 10% neutral buffered formalin. The dressing was taken off after a week. All went well with the recovery [Figure 1].

Figure 1.

(a) Preoperative view. (b) Intraoperative view. (c) Postoperative view

Histopathological analysis indicated pseudoepitheliomatous hyperplasia in the surface stratified squamous epithelium, with isolated regions of ulceration and hemorrhage. Subepithelial tissue showed the proliferation of capillaries lying in a lobular pattern surrounded by their thick fibrous stroma. In some of the sections, bits of lamellar bone were seen.

Histopathological features were consistent with a clinical diagnosis of pyogenic granuloma.

Case 2

A 37-year-old woman visited the Dental College and Hospital in Patiala, Punjab, with a chief complaint of swelling in the mouth’s lower right rear area for the last month. On closer inspection, almost round, reddish-pink growth measuring about 10 mm × 12 mm on the lingual part of the lower right canine–premolar area was seen. The swelling was not painful to the touch, and its texture ranged from soft to hard, with minimal bleed. She had poor oral hygiene.

A provisional diagnosis of pyogenic granuloma was made. Using electrocautery and local anesthesia, the lesion was removed in its entirety after nonsurgical treatment.

The removed tissue was transferred for standard histological analysis. The recovery process went off without a hitch. Mucosal epithelium bordered by stratified squamous epithelium with localized regions of ulceration and acute inflammatory cell infiltration was seen in hematoxylin and eosin-stained sections, according to the histopathology report. Subepithelium showed proliferation of capillaries separated by edematous stroma, which was infiltrated by chronic inflammatory cells, multinuclear giant cells, and fibroblastic proliferation. These findings along with clinical correlation are diagnostic to pyogenic granuloma.

DISCUSSION

Oral pyogenic granuloma is a hyperplastic, inflammatory development. Tooth trauma, initial tooth damage, chronic irritation, hormonal fluctuations, drug side effects, gingival inflammation, some preexisting vascular lesions in patients, chronic irritation, the eruption of permanent teeth, poor fillings in the area of the tumor, food impaction, complete periodontitis, toothbrush trauma, etc., have been postulated in its etiology.[3]

Female sex hormones may affect blood vessels, which may explain why women tend to be the ones who experience these effects. The risk is greatest in the second to fifth decades of life. The gingiva is the most common area of the mouth to be damaged (75%), followed by the tongue, hard palate, lip, buccal mucosa, and mouth floor.[4]

The literature provides different treatment options for pyogenic granuloma. Surgical excision is the most common approach used. Other therapeutic options include electrocauterization, cryotherapy, and laser therapy, all of which have provided positive outcomes. In this case series, two patients were treated with electrocautery, and in one of the patients, the lesion was excised by the conventional approach.[5]

Re-excision of the lesion is then necessary.

However, none of the patients showed recurrence in this present case series after successful excision of the lesion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.