Histologically, the lesion shows a highly vascular proliferation that resembles granulation tissue.
Numerous small and larger endothelium-lined channels are formed that are engorged with red blood cells. These vessels sometimes are organized in lobular aggregates, and may be called as lobular capillary haemangioma.
The surface is usually ulcerated and replaced by a thick fibrinopurulent membrane.
A mixed inflammatory cell infiltrate of neutrophils, plasma cells, and lymphocytes is evident.
Neutrophils are most prevalent near the ulcerated surface; chronic inflammatory cells are found deeper in the specimen.
5. Past Medical History – Hypertensive, Asthmatic, had Kidney Infection and
was a Cardiac Patient
Medications – Anti-Hypertensive Drugs, Diuretics and Bronchodilators
Past Dental History – No past dental history
Family History – No relevant family history
General Physical Gait – Normal Built, Co-operative with Normal Gait
6. PERSONAL
HISTORY
Married/ Unmarried –Married
Educational Status – Graduate
HABITS
Patient cleaned her teeth with toothpaste
once daily for 2 minutes
She had no deleterious habits
7. EXTRA ORAL
EXAMINATION
Patient was Fair
Lips were Normal Pink in Colour
TMJ Movements – Normal
Lymph Nodes – Non-palpable
9. GROWTH
Number – 1
Location And Extent – On left buccal
mucosa extending from retromolar area to
lower left second molar
Colour – Yellowish Pink
Size – 3 cm x 2 cm
Consistency – Firm and elevated lesion
Shape – Semi-circular
Margins – Well defined margins
Fluctuant
Tender
10. Contoso
S u i t e s
YELLOWISH PINK IN COLOUR
SEMI-CIRCULAR SHAPE WITH WELL
DEFINED MARGINS
ON LEFT BUCCAL MUCOSA EXTENDING
FROM RETROMOLAR AREA TO LOWER
LEFT SECOND MOLAR
14. BIOPSY
Excisional biopsy was done in the Department
of Oral and Maxillofacial Surgery and the tissue
was sent to the Department of Oral Pathology
for histopathological examination
15. MACROSCOPIC
DETAILS
Received 1 small soft tissue specimens
measuring
2.2 cm x 2.0 cm
Firm in consistency
Yellowish-white in colour
16. MICROSCOPIC
EXAMINATION
The H & E stained tissue section revealed
epithelium and connective tissue stroma.
Epithelium was proliferative stratified
squamous and was ulcerated at places.
Underlying connective tissue was composed of
collagen bundles, numerous blood vessels,
proliferating endothelial cells, extravasated
RBCs and inflammatory cells.
17. Contoso
S u i t e s
OVERLYING EPITHELIUM
UNDERLYING CONNECTIVE TISSUE
WITH MINOR SALIVARY GLANDS
18. Contoso
S u i t e s
STRATIFIED SQUAMOUS
EPITHELIUM
CONNECTIVE TISSUE STROMA
COLLAGEN BUNDLES AND
INFLAMMATORY CELLS
ULCERATED EPITHELIUM
ENDOTHELIUM LINED BLOOD
VESSELS AND EXTRAVASATED RBCs
22. It is most common in children and young adults
23. The ulcerated area of the
lesion is often covered by a
yellow fibrinous membrane.
Bleeds easily because of
its extreme vascularity.
24.
25.
26. DIFFERENTIAL DIAGNOSIS
Mortazavi H, Safi Y, Baharvand M, Rahmani S, Jafari S. Peripheral Exophytic Oral Lesions: A Clinical Decision Tree. Int J Dent. 2017;2017:9193831.
27. HISTOLOGICFEATURES
Histologically, the lesion shows a highly vascular proliferation that
resembles granulation tissue.
Numerous small and larger endothelium-lined channels are formed
that are engorged with red blood cells. These vessels sometimes are
organized in lobular aggregates, and may be called as lobular capillary
haemangioma.
The surface is usually ulcerated and replaced by a thick
fibrinopurulent membrane.
A mixed inflammatory cell infiltrate of neutrophils, plasma cells, and
lymphocytes is evident.
Neutrophils are most prevalent near the ulcerated surface; chronic
inflammatory cells are found deeper in the specimen.
NEVILLE’S TEXTBOOK OF ORAL AND MAXILLOFACIAL PATHOLOGY 3RD EDITION
28.
29.
30.
31. TREATMENT
Pyogenic granuloma is treated by surgical excision.
Excision and biopsy of the lesion is the recommended line of
treatment unless it would produce a marked deformity and in such a
case incisional biopsy is recommended. Conservative surgical excision
of the lesion with the removal of irritants such as plaque, calculus,
and foreign materials is recommended for small painless nonbleeding
lesions. Excision of the gingival lesions up to the periosteum with
through scaling and root planning of adjacent teeth to remove all
visible sources of irritation is recommended.
Newadkar UR, Khairnar S, Dodamani A. Pyogenic granuloma: A clinicopathological analysis of fifty cases. J Oral Res
Rev 2018;10:7-10
32. REFERENCES
SHAFER’S TEXTBOOK OF ORAL PATHOLOGY 7TH EDITION
NEVILLE’S TEXTBOOK OF ORAL AND MAXILLOFACIAL
PATHOLOGY 3RD EDITION
Newadkar UR, Khairnar S, Dodamani A. Pyogenic granuloma: A
clinicopathological analysis of fifty cases. J Oral Res Rev 2018;10:7-10
Mortazavi H, Safi Y, Baharvand M, Rahmani S, Jafari S. Peripheral
Exophytic Oral Lesions: A Clinical Decision Tree. Int J Dent.
2017;2017:9193831.