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Oral pyogenic granuloma: Various concepts of etiopathogenesis



Pyogenic granuloma or granuloma pyogenicum is a well-known oral lesion. The name pyogenic granuloma is a misnomer since the condition is not associated with pus and does not represent a granuloma histologically. Pyogenic granuloma of the oral cavity is known to involve the gingiva commonly. Extragingivally, it can occur on the lips, tongue, buccal mucosa, palate, and the like. A history of trauma is common in such sites. The etiology of the lesion is not known, though it was originally believed to be a botryomycotic infection. It is theorized that pyogenic granuloma possibly originates as a response of tissues to minor trauma and/or chronic irritation, thus opening a pathway for invasion of nonspecific microorganisms, although microorganisms are seldom demonstrated within the lesion. Pathogenesis of pyogenic granuloma is still debatable. Medline and PubMed databases were searched under the following key terms: Pathogenesis of oral pyogenic granuloma, pyogenic granuloma, and oral pyogenic granuloma. This search was limited to articles on human/animal studies which were published in English language. After reviewing the searched articles, the relevant articles were selected for the present review. Through this article, we have tried to summarize and present all the concepts of pathogenesis related to this most common and most mysterious oral lesion.
Journal of Oral and Maxillofacial Pathology Vol. 16 Issue 1 Jan - Apr 2012 79
Soft tissue enlargements of the oral cavity often present a
diagnostic challenge because a diverse group of pathologic
processes can produce such lesions. An enlargement
may represent a variation of normal anatomic structures,
inammation, cysts, developmental anomalies, and neoplasm.
Within these lesions is a group of reactive hyperplasias,
which develop in response to a chronic, recurring tissue
injury that stimulates an exuberant or excessive tissue repair
response. Pyogenic granuloma is of the most common entities
responsible for causing soft tissue enlargements.
Occurrence of pyogenic granuloma in man was rst described
in 1897 by Poncet and Dor. At that time, it was called
botryomycosis hominis. Pyogenic granuloma has been referred
to by a variety of other names such as granuloma pediculatum
benignum, benign vascular tumor, pregnancy tumor, vascular
epulis, Crocker and Hartzell’s disease. It was given its present
name by Crocker in 1903.[1] However, some researchers believe
that Hartzell in 1904 introduced the term “pyogenic granuloma”
that is widely used in the literature, although, it does not express
accurately the clinical or histopathologic features.[2]
Angelopoulos AP proposed the term “hemangiomatous
granuloma” that accurately expresses the histopathologic
picture (hemangioma like) and the inammatory nature
(granuloma) of oral pyogenic granuloma.[2] Cawson et al.
suggested that since the blood vessels are so numerous in oral
pyogenic granuloma, alternative term for pyogenic granuloma
is granuloma telangiectacticum.[3]
Pyogenic granuloma is well known in dermatology as skin
is a common site for this lesion. The term lobular capillary
hemangioma is increasingly gaining favor in the dermatologic
Bhaskar et al. in their study observed that oral pyogenic
granuloma comprized about 1.85% of all oral pathoses,
Oral pyogenic granuloma: Various concepts of
Reet Kamal, Parveen Dahiya1, Abhiney Puri2
Departments of Oral and Maxillofacial Pathology, HPGDC, Shimla Himachal Pradesh, 1Department of Periodontics and 2Oral and Maxillofacial
Pathology, Himachal Institute of Dental Sciences, Paonta Sahib, Sirmour Himachal Pradesh, India
Address for correspondence:
Dr. Reet Kamal,
Department of Oral and Maxillofacial
Pathology, HPGDC, Shimla
Himachal Pradesh - 177 001, India.
Pyogenic granuloma or granuloma pyogenicum is a well-known oral lesion.
The name pyogenic granuloma is a misnomer since the condition is not
associated with pus and does not represent a granuloma histologically.
Pyogenic granuloma of the oral cavity is known to involve the gingiva commonly.
Extragingivally, it can occur on the lips, tongue, buccal mucosa, palate, and
the like. A history of trauma is common in such sites. The etiology of the lesion
is not known, though it was originally believed to be a botryomycotic infection.
It is theorized that pyogenic granuloma possibly originates as a response of
tissues to minor trauma and/or chronic irritation, thus opening a pathway for
invasion of nonspecic microorganisms, although microorganisms are seldom
demonstrated within the lesion. Pathogenesis of pyogenic granuloma is still
debatable. Medline and PubMed databases were searched under the following
key terms: Pathogenesis of oral pyogenic granuloma, pyogenic granuloma,
and oral pyogenic granuloma. This search was limited to articles on human/
animal studies which were published in English language. After reviewing the
searched articles, the relevant articles were selected for the present review.
Through this article, we have tried to summarize and present all the concepts
of pathogenesis related to this most common and most mysterious oral lesion.
Key words: Etiopathogenesis, oral, pyogenic granuloma
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Journal of Oral and Maxillofacial Pathology: Vol. 16 Issue 1 Jan - Apr 2012
Etiopathogenesis of oral pyogenic granuloma Kamal, et al.80
other than caries and gingivitis treated at US Army Institute
of Dental Research.[1] Daley et al. found that pregnancy
epulides accounted for only 42 of the 757 epulides of all
types.[4] According to Cawson et al. oral pyogenic granuloma
is relatively common. It represents 0.5% of all skin nodules in
children. The pregnancy tumor variant of pyogenic granuloma
occurs in up to 5% of pregnancies.[3] Esmeili et al. in their
review stated that hyperplastic reactive lesions represent as
a group the most common oral lesions, excluding caries,
periodontal, and periapical inammatory disease. In this
group, the second most common group is represented by
hyperplastic reactive gingival/alveolar lesions, including
inammatory gingival hyperplasia, oral pyogenic granuloma,
peripheral giant-cell lesion and peripheral cemento-ossifying
broma.[5] Peralles et al. in their clinicopathologic study
conducted on gingival and alveolar hyperplastic reactive
lesions observed that inammatory gingival hyperplasia and
oral pyogenic granuloma were the most common diagnosis.[6]
In an analysis of 244 cases of gingival lesions in south Indian
population, Shamim et al. found that nonneoplastic lesions
accounted for 75.5% of cases with oral pyogenic granuloma
being most frequent lesion, accounting for 52.71% cases.[7]
Some authors regard pyogenic granuloma as an “infectious”
entity. Kerr has reported staphylococci and botryomycosis,
foreign bodies, and localization of infection in walls of blood
vessel as contributing factors in the development of the
lesion.[8] Bhaskar et al. observed that bacterial stains have
demonstrated the presence of gram positive and gram negative
bacilli in oral pyogenic granuloma. But they also suggested
that as these organisms were more common in ulcerated than
in non ulcerated lesions and more common near surface than
in deeper aspects that suggest that these organisms may have
been contaminants from oral ora.[1] According to Shafer
et al., oral pyogenic granuloma arises as a result of infection
by either staphylococci or streptococci, partially because it
was shown that these microorganisms could produce colonies
with fungus-like characteristics. They also stated that it is now
generally agreed that oral pyogenic granuloma arises as a result
of some minor trauma to the tissues that provide a pathway for
invasion of nonspecic types of microorganisms. The tissues
respond in a characteristic manner to these organisms of low
virulence by the overzealous proliferation of a vascular type of
connective tissue. They explain the mechanism by suggesting
that tissue response reiterates the well-known biologic
principle that any irritant applied to living tissue may act either
as a stimulus or as a destructive agent or both. If many cells
are present in a small volume of tissue and there is a relative
reduction of blood ow through the area as in inammation,
the concentration of the stimulating substance will be high and
growth will be stimulated. As differentiation and maturation
are attained, the cells become widely separated and the
concentration of the substance falls and little growth occurs.
In this type of inammation that results in the formation of
oral pyogenic granuloma, destruction of xed tissue cells is
slight but stimulus to proliferation of vascular endothelium
persists and exerts its inuence over a long period of time.[9]
Reichart et al. stated that granulation tissue in oral pyogenic
granuloma may become contaminated by ora of oral cavity
and its surface may often become covered by brin which may
mimic pus. However, still suppuration is not a characteristic
of oral pyogenic granuloma to support infectious origin.[10]
Some investigators consider pyogenic granuloma as a
“reactive” or “reparative” tumor process. Regezi et al. suggest
that pyogenic granuloma represents an exuberant connective
tissue proliferation to a known stimulus or injury like calculus
or foreign material within the gingival crevice.[11] Several
“etiologic factors” such as trauma, injury to a primary tooth,
chronic irritation, hormones, drugs, gingival inammation,
preexisting vascular lesions, chronic irritation due to
exfoliation of primary teeth, eruption of permanent teeth,
defective llings in the region of tumor, food impaction, total
periodontitis, toothbrush trauma, etc. have been suggested
as etiological factors where patients presented with these
Murata et al. 1997 in their study observed that after any trauma,
the key to wound healing is the formation of granulation
tissue and this includes the migration of inammatory
cells, migration and proliferation of vascular endothelial
cells and broblasts and synthesis of extracellular matrix.
Such processes of wound healing seem to be controlled by
various kinds of cytokines. Out of these cytokines – role
of growth factors, particularly bFGF – a heparin binding
angiogenic protein, has been found to be highly mitogenic
for capillary endothelial cells and to induce angiogenesis.
They studied bFGF immunolocalisation in gingiva and oral
pyogenic granuloma at its various stages of progression.
They suggested that maximum amounts of bFGF are
synthesized and released from some macrophages and mast
cells into extracellular matrix during neovascularisation of
the granulation tissue.[13]
Trauma has also been implicated in etiopathogenesis of
multiple and satellite oral pyogenic granuloma, although,
exact etiopathogenesis that whether it occurs following
treatment or de novo, is not clearly understood. But various
theories have been proposed. Ainamo suggested that trauma
can cause release of various endogenous substances including
angiogenic factors from the tumor cells and it may also cause
disturbances in the vascular system of the affected area. As
there is a site predilection for labial gingiva in the anterior
region of the oral vestibule, some authors have postulated that
habitual tooth brushing may also be considered as a signicant
cause of microtrauma and irritation to the gingiva.[14]
Yung, Richardson, and Krotochvil suggested hormonal
inuence on the basis of the observation that pregnancy
tumor that occurs in the pregnant women also arises from
Journal of Oral and Maxillofacial Pathology: Vol. 16 Issue 1 Jan - Apr 2012
Etiopathogenesis of oral pyogenic granuloma Kamal, et al.81
the gingiva and has the same microscopic appearance.[15]
Hosseini et al. stated that there are clinical observations that
gingiva may be enlarged during pregnancy and may atrophy
during menopause. On basis of these observations, gingiva
can be regarded as another “target organ” for direct action
of estrogen and progesterone.[16] In Whitaker et al., study, it
was suggested that the quantity of estrogen or progesterone
receptors in oral pyogenic granuloma is not the determining
factor in its pathogenesis of. Rather, such a role could be
attributed to the levels of circulating hormones. The levels of
estrogen and progesterone are markedly elevated in pregnancy
and could therefore exert a greater effect on the endothelium
of oral pyogenic granuloma.[17] Ojanotak-Harri et al. (1991)
stated that it has been shown that pregnancy inhibits the
migration of inammatory cells and broblasts. Hence,
it seems that pregnancy regulates both the metabolism of
progesterone and also inuences migration of inammatory
cells in tissue. The level of progesterone available in the
active form and “dysfunction” of the inammatory cells
may have a role in development of pregnancy gingivitis and
granuloma formation. They suggested co-existence of the
two factors prevent acute type of tissue reaction (which keep
tissues clinically healthy) to plaque, but allows an increased
chronic reaction resulting clinically in an exaggerated
appearance of inammation.[18] But, Bhaskar and Jacoway
observed that pyogenic granuloma occurs almost as often
in males as females; for this reason, a hormonal basis is
Regezi et al. (2003) stated that oral pyogenic granuloma
shows obvious histopathological ndings of prominent
capillary growth in hyperplastic granulation tissue suggesting
a strong activity of angiogenesis.[10]. Kuo, Ying, and Ming
stated the role of two angiogenesis enhancers, that is, VEGF
and bFGF, and two angiogenesis inhibitors, that is, TSP-1
and angiostatin in mechanism for angiogenesis. Vascular
morphogenesis factors Tie-2, angiopoietin-1, angiopoietin-2,
ephrinB2, and ephrinB4 were found upregulated in pyogenic
granuloma compared to healthy gingiva.[19] The importance of
decorin, vascular endothelial growth factor, basic broblast
growth factor, or connective tissue growth factor particularly
in angiogenesis associated with a profound inammation has
been proved by some investigators.[12]
Kelley and Bernard regard pyogenic granuloma as a “Benign,
Acquired, Vascular, Neoplasm”.[20] According to Cawson
et al., pyogenic granuloma represents vascular proliferations
and do not represent a stage in the development of brous
nodules or merely inamed brous nodules. Regarding the
pregnancy pyogenic granuloma, they state that like pyogenic
granulomas in a nonpregnant women, pregnancy tumor may
show minimal or no inammation, but vascular proliferation
is occasionally very active so as to suggest a neoplasm.
Nevertheless, the behavior is benign.[21] Davies et al., found
inclusion bodies in the broblasts suggestive of disordered
protein metabolism.[22]
Oral pyogenic granuloma occurs over a wide age range of 4.5
to 93 years with highest incidence in second and fth decades
and females are slightly more affected than males. Gingiva was
the predominant site followed by lips, tongue, buccal mucosa,
and hard plate. Other sites were the cheek, lips, tongue, palate,
mucobuccal fold, and frenum. Intraorally, it can present with
a wide array of clinical appearances, ranging from a sessile
lesion to an elevated mass. Pyogenic granulomas generally
are soft, painless, and deep red to reddish-purple in color.[1]
Radiographic ndings are absent in pyogenic granuloma.
However, angelopoulos AP in his review observed that
localized alveolar bone resorption in rare instances of large
and long standing gingival tumors can be seen.[2]
Pyogenic granuloma is partly or completely covered
by parakeratotic or non-keratinized stratied squamous
epithelium. Major bulk of the lesion is formed by a lobulated or
a non lobulated mass of angiomatous tissue. Usually, lobulated
lesions are composed of solid endothelial proliferation or
proliferation of capillary sized blood vessels. The amount of
collagen in the connective tissue of pyogenic granuloma is
usually sparse. Surface can be ulcerated and in such ulcerated
lesions, edema was a prominent feature and the lesion is
inltrated by plasma cells, lymphocytes and neutrophils.[1]
Sangueza and Requena stated that pyogenic granuloma lesions
express factor VIII – related antigen positivity in the endothelial
cells lining large vessels, but are negative in the cellular
areas, whereas Ulex europaeus I lectin binds to endothelial
cells in both large vessels and cellular aggregates. Enhanced
expression of the bFGF, Tie-2, anti-CD34 and anti alpha
SMA antibodies, and vascular morphogenesis factors such as
angiopoietin-1, angiopoietin-2, ephrinB2, and ephrinB4. There
is also expression of inducible nitric oxide synthase, increased
expression of vascular endothelial growth factor, low apoptotic
rate expression of Bax/Bcl-2 proteins and strong expression of
phosphorylated mitogen activated protein kinase. Polymerase
chain reaction investigations for human papilloma virus and
human herpes virus type have yielded negative results.[23]
Differential diagnosis of pyogenic granuloma includes
peripheral giant cell granuloma, peripheral ossifying broma,
broma, peripheral odontogenic broma, hemangioma,
conventional granulation tissue, hyperplastic gingival
inammation, Kaposi’s sarcoma, bacillary angiomatosis,
angiosarcoma, and nonHodgkin’s lymphoma.[10,24]
Journal of Oral and Maxillofacial Pathology: Vol. 16 Issue 1 Jan - Apr 2012
Etiopathogenesis of oral pyogenic granuloma Kamal, et al.82
Surgical excision is the treatment of choice.[10] After surgical
excision of gingival lesions, curettage of underlying tissue is
recommended.[25] Excision with 2 mm margins at its clinical
periphery and to a depth to the periosteum or to the causative
agent. Any foreign body, calculus, or defective restoration
should be removed as part of the excision.[26]
Bhaskar and Jacoway has reported recurrence rate of 15.8%
after conservative excision.[1] Vilmann et al. observed that
gingival cases show a much higher recurrence rate than lesions
from other oral mucosal sites. Pyogenic granuloma lacks
inltrative or malignant potential.[27] Sapp et al. stated that oral
pyogenic granulomas have a relatively high rate of recurrence
after simple excision. If patient is pregnant, recurrence is
common. Recurrence after surgery in extragingival sites
is uncommon.[28] Lawoyin et al. observed no recurrence in
cases treated by surgical excision.[29] Al-Khateeb et al. (2003)
observed a recurrence rate of 5.8% in his study.[30]
Pyogenic granuloma or granuloma pyogenicum is a
well-known oral lesion. However, etiopathogenesis of oral
pyogenic granuloma is still debatable. This article thus
attempted to review the main theories of etiopathogenesis and
the basis for such observations.
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3. Cawson RA, Binnie WH, Speight PM, Barrett AW, Wright JM.
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fibroblast growth factor during epulis formation: An
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15. Yih WY, Richardson L, Kratochvil FJ, Avera SP, Zieper MB.
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19. Yuan K, Jin YT, Lin MT. Expression of Tie-2, angiopoietin-1,
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How to cite this article: Kamal R, Dahiya P, Puri A. Oral pyogenic
granuloma: Various concepts of etiopathogenesis. J Oral Maxillofac
Pathol 2012;16:79-82.
Source of Support: Nil. Conict of Interest: None declared.
... Pyogenic granuloma (PG) is a benign connective tissue proliferation that is predominantly characterized by granulation tissue hyperplasia, and it occurs frequently in the skin or mucous membranes [1][2][3][4]. It is considered one of the most common lesions responsible for soft tissue enlargements, due to its rapid and alarming growth rate [1,[5][6][7]. ...
... In the oral cavity, the gingiva accounts for 75% of the sites of predilection of this pathology. However, PG may occur in other areas such as the lips, tongue, buccal mucosa, hard plate and peri-implant mucosa, and it affects the maxilla more than the mandible, the anterior region more than the posterior region, with the buccal surfaces more affected than the lingual surfaces [2][3][4]. In the literature, the floor of the mouth is not considered as a site of occurrence of PG. ...
... The features used for differential diagnosis of oral PG include red or reddish-blue growths such as gingival hyperplasia, peripheral giant cell granuloma, hemangiomas, conventional granulation tissue, peripheral ossifying fibroma, peripheral odontogenic fibroma, metastatic cancer, Kaposi's sarcoma, bacillary angiomatosis, angiosarcoma, and non-Hodgkin's lymphoma [2][3][4]10,26]. ...
Full-text available
Pyogenic granuloma (PG) is a benign vascular lesion found predominantly in the oral cavity. Characterized by rapid growth and propensity to bleed, PG presents diagnostic challenges due to its similarity and alarming proliferation. This narrative review synthesizes current knowledge on the epidemiology, etiopathogenesis, clinical manifestations, and management of oral PG, with emphasis on recent advances in diagnostic and therapeutic approaches. The epidemiology of the injury is meticulously analyzed, revealing a higher incidence in women and a wide range of ages of onset. It delves into the etiopathogenesis, highlighting the uncertainty surrounding the exact causal factors, although historical attributions suggest an infectious origin. It exhaustively analyzes the clinical and histopathological aspects of oral PG, offering information on its various presentations and the importance of an accurate diagnosis to guide effective treatment. It details treatment strategies, emphasizing the personalized approach based on individual patient characteristics. This comprehensive review consolidates current knowledge on oral PG, highlighting the need for further research to clarify its pathogenesis and optimize treatment protocols.
... Pyogenic granuloma (PG) is a common reactive exophytic pedunculated or sessile soft tissue growth that can occur in the oral cavity [1,2]. ...
... Although PG may develop at any age, the highest prevalence was in the second decade. Pyogenic granuloma occurs more commonly in females, which may be attributed to the vascular effects of female hormones [1,5,6]. ...
... The recurrence rate after conservative excision is approximately 16%, with a higher chance of recurrence when it involves the gingiva or appears in pregnant women. Incomplete surgical removal, failure to eliminate the cause, and new trauma to the area can lead to recurrence [1,2,10]. ...
Full-text available
Pyogenic granuloma (PG) is a common reactive oral lesion predominantly involving the gingiva and rarely occurring on the dorsum of the tongue. It can develop at any age but more commonly in the second decade with a female predilection. Numerous factors are associated with its development, and surgical removal is the standard treatment. Various surgical modalities have been used to excise it. Herein, we report a case of a female patient in her late 60s who presented with an exophytic lesion involving the dorsum of the tongue, which was excised using a 940 nm diode laser. In addition, it discusses the advantages of diode laser as a surgical modality and describes this lesion's clinical features and pathogenesis.
... Pyogenic granuloma (PG) is a benign connective tissue proliferation that is predominantly characterized by granulation tissue hyperplasia, and it occurs frequently in the skin or mucous membranes [1][2][3][4]. It is considered as one of the most common lesions responsible for soft tissue enlargements, due to its rapid and alarming growth rate [1,[5][6][7]. ...
... There are some discrepancies in the epidemiological pattern of this pathology. Oral PG manifests within the range of 4.5 to 93 years, and it shows a preeminent incidence in the second and fifth decades, with the female gender often being more affected than the male gender [3,4]. On the other hand, some researchers have suggested that this disease manifests mostly in males younger than 18 years and in females aged 18-39 years, with equal gender distribution in older patients [10]. ...
... However, the exact cause is unknown. Historically, some researchers consider it to be a pathology attributable to an infectious agent, hence the term "pyogenic" [3,18]. Kerr in 1951 was of the view that the factors that influence the progression of PG were bebotryomycosis, staphylococci, foreign particles, and the accumulation of infection in the endothelium of blood vessels. ...
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Oral pyogenic granuloma (PG) is generally a solitary benign connective tissue proliferation of unknown etiology. It is the most common type of oral inflammatory hyperplasia histologically characterized by proliferation of granulation tissue with inflammatory infiltrates and high angiogenic capacity. Vascular neoformations of different diameters are usually present. Due to their structural characteristics, tendency to bleed, and rapid and alarming growth rate, these neoformations may have serious consequences. Sometimes, it is complex to make an accurate diagnosis. Therefore, adequate management and treatment are based on the characteristics and systemic conditions of each patient. This review was carried out to provide an overview of the factors involved in, or attributed to the etiopathogenesis of oral PG. It describes the different forms of presentation and clinical evolution, as well as the most frequent signs and symptoms that characterize this disease, while incorporating recent radiographic and microscopic findings. In addition, it describes the different modalities for the management of oral pyogenic granuloma depending on the particular characteristics of each patient.
... Pyogenic granulomas commonly coexist with gingivitis and most often grow rapidly, ulcerate, and presents as a localised polypoid mass red or reddish-purple nodule which is pedunculated or sessile can either be misdiagnosed as a malignancy unless proved by histopathology. [11] When any lesion particularly nodular is seen in oral cavity clinical management of a pyogenic granuloma with appropriate antibiotic usage and improving oral health care with proper dental care and habits can help in better control of lesions of the gums and gingiva. ...
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Introduction Oral cavity can be host to multitude of neoplastic, premalignant or non neoplastic pathological lesions. Diagnosis of lesions of oral cavity is always of interest to clinician and pathologist and rely on clinical appearance of lesions. There can be variation in diagnosis of clinical lesion with histopathology. Many oral carcinomas arise within the sites that previously had premalignant lesion. Incidence of oral cancers in population has increased among younger generations related to habits and lifestyle. These lesions during clinical presentation are misleading and create diagnostic dilemma owing to age, sex and distribution of lesions. Understanding distribution of oral mucosal lesions helps to diagnose lesions of oral cavity. Purpose of this study is to observe the variation in clinical diagnosis with histopathological diagnosis in patients with inflammatory, premalignant, benign and malignant lesions of oral cavity and oropharynx and also clinical distribution of lesions of oral cavity and oropharynx lesions by histopathology. Observations Out of total 105 lesions, ulcer in oral cavity seen in 58 (55.23%) of patients, followed by swelling or feeling of lump in oral cavity in 36 (34.29%) of patients and foreign body sensation in 23 (21.90%) of patients with tongue as most frequent site for most of lesions of oral cavity accounting in 33 (31.43%) of cases, and less frequently lesions were seen in retro molar trigone area in 2 (1.90%) patients. Histopathological diagnosis of premalignant, non neoplastic and inflammatory lesions was made in 24 (22.85%) cases, benign tumours were diagnosed in 14 (13.33%) cases and rest of 67 (63.81%) lesions were malignant. Mucocoel were seen in five (4.76%) cases, radicular cyst was seen in one (0.95%) case of female patient and four cases of Leukoplakia with one case showing mild dysplasia. Among benign tumours 11 (10.47%) patients presented with gingivitis turned out to be squamous papillomas were seen in five (4.76%) cases, fibroma was diagnosed in four (3.80%) cases, pyogenic granuloma was diagnosed in four (3.80%) cases most commonly seen over gingiva and myoepithelioma of minor salivary gland was observed in one (0.95%) case over soft palate. Out of 67 cases of malignant lesions squamous cell carcinomas were seen in 59 (88.05%) cases followed by verrucous carcinoma in 3 (4.47%) cases, 2 (2.99%) cases were basaloid squamous cell carcinomas, mucoepidermoid carcinoma was seen in 2 (2.99%) cases and 1 (1.49%) case of adenoid cystic carcinoma was seen. Majority of squamous cell carcinomas cases in study were well differentiated in 49 (73.13%) cases followed by moderately differentiated in 16 (23.88%) cases and poorly differentiated in 2 (2.99%) cases. Malignant transformation of tonsil tissue post operatively was observed in 1 (0.95%) patients on histopathology. One (2.5%) case of myoepithelioma was seen in 60 years male over soft palate. Conclusion Of all oral biopsies reported in study, increasing trend of malignancies in lower age groups of population making it an emerging threat to community and highlighting need to take effective measures to increase public awareness about risk factors and consequences of this condition. Screening programmes targeted to population over 25 years are recommended to overcome this.
... The main etiologic factor was thought to be caused by pyogenic organisms, but now it is believed to be unrelated to infection. Therefore, the term "pyogenic granuloma" became a misnomer as it neither contains the pus nor is strictly a granuloma histologically [2,6]. PG is known to involve the gingiva mainly [7]. ...
... The first case to be notified of pyogenic granuloma was in 1897 by Poncet and Dor, and in that period, it was known as botryomycosis hominis. The term was coined by Hartzell in 1904; however, after these years of cytological advancement, Angelopoulos AP stated that on looking out for its hypocellular structure, it should be termed a hemangiomatous granuloma [2]. Pyogenic granuloma is mostly encountered in the maxilla than the mandible; it has a higher affinity for the gingiva, followed by the palate and buccal mucosa. ...
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Pyogenic granuloma is a common reactive oral lesion primarily found in the gingiva and rarely in extraction sockets. While it can develop at any age, it is more prevalent in the third and fourth decades of life with a higher occurrence in females. Various factors contribute to its development and surgical removal is the gold standard treatment; however, there are various other methods available. This case report documents a rare event in which a female patient in her early 40s presented with an exophytic lesion affecting the extraction socket of her maxillary right lateral incisor. The lesion was effectively removed through surgical excision. Additionally, it explores the clinical features and pathogenesis of this lesion. The purpose of this case report is to shed light on the uncommon incidence of pyogenic granuloma following tooth extraction. This non-neoplastic vascular growth often presents as an erythematous, ulcerated lesion with a tendency to bleed, with either a sessile or pedunculated base. Our case is one of only five instances documented in the literature, underscoring the importance of knowledge and timely response in such unusual circumstances. We emphasize the significance of early detection and management for improved patient outcomes and a better understanding of this rare condition.
Background Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder presenting with an inability to repair UV‐induced DNA damage. This can lead to the development of neoplasms affecting multiple organ systems, with onset often in childhood. Unfortunately, no cure currently exists for XP, and management strategies focus on sun protection and early intervention for malignancies. Although most skin problems in XP patients are UV induced, various oral lesions are also described. However, the literature has not extensively characterized the oral manifestations and their prognostic significance. Methods We conducted a comprehensive review to evaluate the prevalence and nature of oral mucosal lesions in pediatric XP patients. Results Our literature search yielded 130 pediatric XP patients with oral involvement and 210 associated tumoral or non‐tumoral lesions. Squamous cell carcinoma was the most common type of oral mucosal tumor reported, with other malignancies including basal cell carcinoma, melanoma, angiosarcoma, fibrosarcoma, and trichilemmal carcinoma. Conclusion Given the potential morbidity and mortality associated with oral mucosal tumors in XP patients, our study aims to raise awareness of these manifestations. Early diagnosis and treatment are crucial for managing these lesions effectively, and routine oral exams should be considered a critical component of dermatological evaluations for XP patients, especially in the pediatric age group.
The reactive lesions are comparatively common in the oral cavity that dentist face during routine examination because of the frequency with which the tissues are injured. They frequently result from a well-known provocation or injury such as plaque, calculus, or foreign bodies. Diagnosis and development of a treatment plan is difficult if dentists are not aware of the prevalence and clinical symptoms of these lesions. The aim of this article was to review the clinical features of various reactive hyperplastic lesions of the oral cavity. The most commonly found lesions are irritational fibroma, pyogenic granuloma, epulis fissuratum, peripheral giant cell granuloma.
El granuloma piógeno tiene una incidencia del 21% de las lesiones tumorales. Clínicamente se presenta como un nódulo exofítico, liso o lobulado, generalmente asintomático y que frecuentemente exhibe una base pedunculada y varía en color desde rojo rosado a púrpura. En el presente artículo se presenta a un paciente masculino de 39 años con un aumento de volumen en el tejido gingival de la zona anteroinferior al cual se le realizó una escisión quirúrgica y al análisis histopatológico se diagnosticó como granuloma piógeno. El tratamiento de elección para esta lesión consiste en la escisión quirúrgica con curetaje del tejido subyacente, sin embargo, presenta una tasa de recurrencia del 15.8%. Palabras clave: granuloma piógeno, granuloma, épulis.
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Some lesions in the oral cavity and mostly on gingiva have predominant predilection towards females, and mostly occur in the first four decades of life when changes in sex hormone levels in blood are obvious. The present study aimed to investi- gate the presence and distribution of estrogen and progesterone receptors in peripheral giant cell granuloma (PGCG), pyo- genic granuloma (PG) and peripheral ossifying fibroma (POF) on gingiva as an organ target. In a descriptive case series study from March 2002 to April 2003, paraffin blocks from patients with exophitic lesion on gingiva, diagnosed by histopathology as PGCG, PG or POF at Dentistry Faculty of Tehran University of Medical Sciences (TUMS), Iran, were analyzed with Immunohistochemical (IHC) technique. The data analysis was performed by frequency and descriptive statis- tics. Of 35 patients, 12 estrogen receptors (ERS) and progesterone receptors (PRS) were detected. Nine of them were PRS and three were ERS. Two third of ERS/ PRS were seen in females and one third in males, respectively. In order of decreas- ing frequency the ERS and PRS were found in PG (n=6), POF (n=4) and PGCG (n=2). In this study, ER/ PR were revealed in three lesions. PR was detected in all of three lesions but we could not see ER in PGCG. Thus, gingiva may be considered as a target organ for sex hormones.
Differential diagnosis of Oral and Maxillofacial lesions. Lon ; Mosby Publications. First edition. 1997.p 342-43.
This full colour, simple, interesting and easy to understand textbook introduces the novice dental student to the many oral disease processes. For the practising specialist and general dentist it provides a review of processes fundamental to clinical problems and an understanding of recent developments and changing concepts. The chapters are organised to coincide with the more recent trends in dental education where students are seeing patients earlier and therefore requiring immediate knowledge of some of the more common and less complicated aspects of oral pathology. To accommodate this trend the subjects that are less difficult conceptually and require fewer prerequisites science courses are in the earlier chapters with more complex topics to be found in later chapters. Each chapter includes an outline of the topics, an introduction to the disease processes, followed by a thorough discussion of the common disorders, organised by aetiology, pathogenesis, clinical and radiographic features, histopathology, differential diagnosis, treatment and prognosis. Each chapter concludes with a short bibliography of the most recent and pertinent review articles and classic publications.
Hyperplastic reactive gingival/alveolar lesions are one of the most common subgroups of oral lesions, however few studies have focused their clinical and microscopic characteristics on our population. The aim of this study was to analyze the socio-demographic, clinical and microscopical features of 90 hyperplastic reactive gingival/alveolar lesions from an Oral Pathology Laboratory from Rio de Janeiro, Brazil. Inflammatory gingival hyperplasia (IGH) and pyogenic granuloma (PG) were the most common diagnosis in this group. Females on their 3rd to 4th decades of life were the predominant group affected and most cases affected the anterior portion of the oral cavity. Histopathology revealed that all cases were associated to chronic inflammatory infiltrate and vascular proliferation was prominent in PG. Epithelial alterations were also more common in PG, but mineralization showed marked affinity for peripheral cemento-ossifying fibroma (PCOF). Fibroblastic proliferation was more evident on PCOF and peripheral giant cell lesion (PGCL) and multinucleated giant cells were found exclusively on PGCL. Clinical and socio-demographic findings alone were not enough for distinguishing all lesions from this group, and our findings showed that few cases were suggestive of an evolutionary process.
The metabolism of progesterone may play a special role in the gingival physiology. The lower the metabolism the higher its hormonal activity in the tissue. In healthy human gingiva, progesterone is metabolized only partially and is therefore in an active form. In the present study, gingival samples from pregnancy gingivitis (n = 1) and granulomas (n = 4) were studied histologically and biochemically. All samples were homogenized and then incubated with [4-14C]-progesterone and NADPH for 2 h at pH 7.4 and 37 degrees C. The metabolites were separated and characterized with column, solvent and thin-layer chromatographies as well as radioautography and quantified with liquid scintillation counting. The results showed low metabolism of progesterone, indicating active hormonal function as in healthy gingiva. It is suggested that progesterone functions as an immunosuppressant in the gingival tissues of pregnant women, preventing the rapid acute-type of inflammatory reaction against plaque, but allowing an increased chronic-type of tissue reaction, resulting clinically in an exaggerated appearance of inflammation.
There is some disagreement about the validity of the clinical term "pregnancy tumor." On the basis of its clinical presentation and histologic appearance, some authors believe that it simply represents a pyogenic granuloma (PG), whereas others believe that the lesion is unique because of the apparent influence of female sex hormones. In an attempt to resolve this problem, a study was undertaken to determine whether a significant correlation exists between PG and pregnancy, and whether the clinical term applies to the other epulides. The study involved 42 epulides diagnosed clinically as pregnancy tumors. A chi-square analysis comparing 32 of these lesions with 757 epulides occurring in women revealed a significant disproportion in the number of PGs, whereas the number of peripheral ossifying fibromas and peripheral giant cell granulomas were within the expected range. Very few focal fibrous hyperplasias (fibromas) were diagnosed as pregnancy tumors. Clinical and behavioral features of pregnancy tumors diagnosed microscopically as PGs were also analyzed. The results indicated that the diagnosis of pregnancy tumor is valid clinically in describing a PG occurring in pregnancy, because it describes a distinct lesion not on the basis of histologic features but on etiology, biologic behavior, and treatment protocol.