Sir,
I write to you in regards to a case report “extragingival pyogenic granuloma histologically mimicking capillary hemangioma.” Authored by Dahiya and Kathuria[1] published in September–October 2014 issue of your reputed Journal. The authors have described the cases excellently, but I have a slight disagreement.
Pyogenic granuloma (PG) is a nonneoplastic tumor of the oral cavity, which shows a predilection for the gingiva. The term PG is now considered a misnomer, as it is not caused by pyogenic organisms and it is not a true granuloma as well.[2]
Histopathologically, PG shows a highly vascular proliferation resembling granulation tissue. Numerous small and large endothelium lined blood vessels engorged by red blood cells are often seen. The channels are often organized in a lobular arrangement thus deriving the term “lobular capillary hemangioma (LCH).” Some pathologists consider PG as a polypoid form of capillary hemangioma or an inflamed lobular hemangioma while others consider it as granulation – tissue type hemangioma.[3]
Two histologic variants of PG have been described: LCH and nonlobular capillary hemangioma (non-LCH). The first type has proliferating blood vessels arranged in lobular aggregates although there may not be any edema, capillary dilation or granulation tissue proliferation. The non-LCH has a highly vascular proliferation resembling granulation tissue.[2,3,4] Varying degrees of inflammatory cells infiltrate are seen in both types of PG.
Considering the above facts in mind, it seems that capillary hemangioma may be the histopathologic diagnosis of a case clinically presenting as PG and they may not be two different entities.
REFERENCES
- 1.Dahiya R, Kathuria A. Extragingival pyogenic granuloma histologically mimicking capillary hemangioma. J Indian Soc Periodontol. 2014;18:641–3. doi: 10.4103/0972-124X.142463. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Neville BM, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 2nd ed. Philadelphia: WB Saunders; 2002. pp. 447–9. [Google Scholar]
- 3.Bouquot JE, Nilai H. Lesions of the oral cavity. In: Gnepp DR, editor. Diagnostic Surgical Pathology of the Head and Neck. Philadelphia: WB Saunders; 2001. pp. 141–233. [Google Scholar]
- 4.Thompson LD. Head and Neck Pathology: Foundations in Diagnostic Pathology. 2nd ed. Philadelphia: WB Saunders; 2012. Lobular capillary hemangioma (pyogenic granuloma) [Google Scholar]