Pyogenic granuloma

The common pyogenic granuloma is typically found on the skin or mucous membranes in the form of pinhead-sized, red, polypoid, strongly vascularized nodules, sometimes with ulcerations. The pathogenesis of pyogenic granuloma is still being debated. Besides the assumption that it is a benign vascular tumor, there is also the theory that pyogenic granuloma corresponds to reactive hyperplasia. The term “pyogenic” is misleading as it suggests an etiology associated with infection, which is not the case. The lesion is very similar to granulation tissue, which initially led to the assumption that it was caused by an infection. Pyogenic granuloma occurs in both men and women and can be found at any age. In about one third of cases, pyogenic granuloma develops as a result of minimal trauma, although the exact mechanism of its development is not known. Pyogenic granulomas grow very fast and reach their maximum size after a few weeks or months, ranging from a few millimeters to a few centimeters. On the skin or the mucous membrane they consist of a polypoid, dark red node which bleeds very easily and can ulcerate.

Clinically pyogenic granulomas are highly characteristic and can often be clearly differentiated from malignant vascular tumors. In childhood, however, it is often not possible to distinguish them from a so-called Spitz nevus, a birthmark that also frequently appears as a reddish nodule. For this reason, surgical removal may be carried out to examine tissue, which is indicated anyway if there is recurrent bleeding.

Special forms of pyogenic granuloma are the granuloma gravidarum (GG) and the intravenous pyogenic granuloma. The granuloma gravidarum typically develops in the first trimester of pregnancy in the area of the gingiva. Clinically and histologically these correspond to the pyogenic granuloma and often show spontaneous regression after birth. Intravenous pyogenic granulomas are frequently located in the head and neck region. Here reddish-brown intravascular polyps are found, which are often interpreted as an organized thrombus. They are derived from the endothelia and are still connected to the vessel wall. They also display the same histologic structure as a pyogenic granuloma.