The pyogenic granuloma is a very common benign proliferation of capillary sized blood vessels. Its characteristic histologic appearance under the microscope leads to its other name, a lobular capillary hemangioma. This lesion are rapidly growing firm red papules that develop within weeks to months. The hands, face, and nasopharynx are favored locations. Disseminated cases may occur.
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EPIDEMIOLOGY CHARACTERISTICS SYNONYMS Lobular capillary hemangioma
Granulation tissue-like hemangioma
PATHOGENESIS CHARACTERIZATION Trauma May precede some lesions
CHARACTERIZATION General VARIANTS Granuloma gravidarum Associated with pregnancy Epulis gravidarum Pregnancy associated tumors arising within the mouth Satellite lesions with recurrence Arch Dermatol 1974;109:689-691
Smaller papules surrounding the original site
Usually younger patients on the upper trunk or shoulder
HISTOLOGICAL TYPES CHARACTERIZATION General
A lobular proliferation of capillary sized vessels, sometimes compartmentalized
Overlying epidermis may be ulcerated but if intact, may form distinct collarettes around the vascular proliferation-this epidermis may be derived from follicular and eccrine ductal epithelium
VARIANTS Extramedullary hematopoiesis Am J Dermatopathol 2000;22:434-438
May be secondary to combination of homing and proliferation factors for stem cells
Extramedullary hematopoiesis in a pyogenic granuloma: a case report and review.
Vega Harring SM, Niyaz M, Okada S, Kudo M.
Department of Pathology, Tokyo Medical University, Tokyo, 160-8402, Japan.
J Cutan Pathol. 2004 Sep;31(8):555-7. Abstract quote
Background: Extramedullary hematopoiesis in the adult life is usually associated with hematological disorders. It can often occur in several organs under certain pathological conditions, including the spleen, liver, and skin, which are normal sites during the embryogenesis, the skin being very uncommon.
Case report: A case of extramedullary hematopoiesis in a granuloma pyogenicum at the anterior aspect of the right thigh of a 31-year-old Japanese man is reported.
Results: Histologic examination revealed an ulcerated polypoid lesion composed of numerous newly formed capillaries and a myxoid edematous stroma. In addition, three islands of hematopoietic precursors were found.
Conclusions: This is, to our knowledge, the second case of extramedullary hematopoiesis in a granuloma pyogenicum. We believe that vascular lesions have potential to generate hematopoietic precursor cells; however, hematopoiesis will only occur in a setting of adequate microenvironment, as it occurs in the bone marrow.
Am J Surg Pathol 1979;3:221-22
Subcutaneous Arch Dermatol 1982;118:30-33
DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES Kaposi's sarcoma Bacillary angiomatosis
PROGNOSIS AND TREATMENT CHARACTERIZATION Treatment Surgical removal but many of these lesions regress spontaneously
Am J Surg Pathol 1980;4:470-479
Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Sixth Edition. WB Saunders 1999.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.
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