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HomePediatrics: General MedicinePediatric Pyogenic Granuloma

Pediatric Pyogenic Granuloma

Background

Pyogenic granulomas (PGs) are benign vascular lesions that occur most commonly on the acral skin of children.
The term pyogenic granuloma is a misnomer. Originally, these lesions were thought to be caused by bacterial infection; however, the etiology has not been determined. The histopathologic appearance is fairly characteristic; the lesion is, in fact, a lobular capillary hemangioma.

Recognition of pyogenic granuloma as a clinically polypoid or exophytic circumscribed lesion is of importance to the clinician and pathologist because this feature distinguishes pyogenic granulomas from most malignant vascular tumors. Although pyogenic granulomas may be multiple (especially on the skin) and necrosis is common, invasion of adjacent structures is not observed. The lesions grow rapidly and are extremely vascular, frequently bleeding either spontaneously or after minor trauma.
They are usually easily treated with surgical removal but may recur.

Uncommon variants include pyogenic granuloma with satellitosis,
intravenous pyogenic granulomas,
subcutaneous pyogenic granulomas,
and eruptive pyogenic granulomas.
Satellite lesions of smaller pyogenic granulomas may develop at the same time as the primary lesion or may occur after attempted treatment of the primary lesion. See the images below.

Pyogenic granulomas are usually solitary lesions.

Pyogenic granulomas are usually solitary lesions. The fingers and hands are common locations for these to develop. A history of minor trauma at the site shortly before development of the lesion is frequent.

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Pyogenic granulomas usually bleed with little or n

Pyogenic granulomas usually bleed with little or no trauma. This patient shows a positive bandage sign. Because the lesions bleed so easily, patients frequently present with a bandage covering the site.

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Pyogenic granulomas usually have a distinct margin

Pyogenic granulomas usually have a distinct margin that consists of a rim of keratin (dry skin). Notice the moist area of skin produced by the bandage, which was removed shortly before the photograph was taken.

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Pyogenic granulomas may be pedunculated and quite

Pyogenic granulomas may be pedunculated and quite large. An area of necrosis is also common.

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Pyogenic granulomas may occur at various sites. Mo

Pyogenic granulomas may occur at various sites. More than 60% of all lesions develop on the head and neck.

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Small pyogenic granuloma.

Small pyogenic granuloma.

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