There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
Dear Editor,
A 28-year-old female presented with a large, 3 cm × 2 cm skin-coloured pedunculated
growth arising from underneath the proximal nail fold of the left fourth digit [Figure
1] for the past 8 months. The lesion was non-tender, had a lobulated consistency and
a smooth surface. There was no history of recurrent bleeding, either spontaneously
or following trauma. Radiologic examination did not reveal any connection with the
underlying bone [Figure 2]. The lesion was completely excised under local anaesthesia
by exposing the base of the peduncle with a diagonal incision running from the junction
of the proximal and lateral nail folds till the distal crease towards the radial side
of the hand. The wound was then closed primarily with a 6–0 non-absorbable suture
[Figure 3]. Clinical differential diagnoses of superficial acral fibromyxoma, lobular
capillary haemangioma and acral fibrokeratoma were considered and specimen was sent
for histopathological analysis. Haematoxylin and eosin analysis showed proliferation
of capillaries arranged in a multilobular fashion occupying almost the entire dermis
with multiple small intralobular capillaries exhibiting well-differentiated lumina
with extravasation of red blood cells [Figure 4a and b]. A final diagnosis of giant
lobular capillary haemangioma (pyogenic granuloma) was established.
Figure 1
A 3 cm × 2 cm skin-coloured pedunculated growth arising from underneath the proximal
nail fold of the left ring finger
Figure 2
A plain X-ray (anterolateral and lateral views) of the left hand showed a well-defined
soft tissue shadow around the tip of the ring finger without any connection with the
distal phalynx
Figure 3
Lesion completely excised with primary closure of the wound
Figure 4
Photomicrograph showing multiple blood vessels occupying almost the entire dermis
(a) H and E, ×100. High power view showed proliferated capillaries with luminal differentiation
and extravasated red blood cells (b) H and E, ×400
Lobular capillary haemangioma or pyogenic granuloma is a common acquired proliferative
vascular lesion affecting the skin and mucous membranes. They appear mostly as solitary
friable vascular papules that may be sessile or pedunculated. The lesions are rapidly
growing and may have polypoid morphology. They do not generally enlarge beyond two
centimetres but giant forms are seen.[1] A surrounding collarette of scale may be
noted at the base of the lesion in most cases. Children and young adults account for
most of the cases although any age, race and either gender may be affected.[2] Trauma,
including burns and surgery, are often implicated in the development of pyogenic granuloma,
so have been certain drugs.[3
4
5
6] Association with pregnancy is a well-known entity as well when the lesions commonly
involve the gingivae. The hands, forearms, face, and the lips are frequently involved.
Multiple eruptive and disseminated forms associated with drugs, burns and exfoliative
dermatitis have also been documented.[7] Bleeding with minimal trauma, ulceration,
or development of multiple satellite lesions following traumatic or surgical destruction
can complicate the existing lesions. The presence of lobular proliferation of capillary-like
vessels, enmeshed in a loose stroma is the hallmark histopathological feature of lobular
capillary haemangioma.[8] Treatment options include shave excision, curettage, cryosurgery
and ablation with neodymium-doped yttrium aluminium garnet laser or pulsed dye lasers
with the choice of treatment guided by the site and extent of the lesion.
Superficial acral fibromyxoma has a similar clinical appearance, as it almost always
involves the digits, and can be seen arising from the nail bed. However, it is mostly
sessile and histopathologically characterised by proliferation of spindle-shaped or
stellate fibroblasts that typically express CD34, CD99, and epithelial membrane antigen.[9]
Acquired digital fibrokeratoma (acral fibrokeratoma) also commonly involves the digits
and usually resembles a rudimentary supernumerary digit with a characteristic moat-like
collarette of skin surrounding its base. Histopathologically, it shows fibrovascular
proliferation in the dermis with an overlying hyperkeratotic and acanthotic epidermis.[10]
Thus lobular capillary haemangioma or pyogenic granuloma should be considered in the
differential diagnosis of vascular lesions in the acral areas.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
This case describes a 2-year-old boy who developed multiple giant pyogenic granulomas on his left upper extremity secondary to a burn injury caused by boiling milk. Here, we present multiple pyogenic granulomas in a burn patient and discuss the possible etiologies of the entity. The pyogenic granulomas were excised and wounds closed with sutures (primary repair) (primary closure). No pyogenic granulomas have recurred after 11 months of follow-up. Pyogenic granuloma with multiple dissemination in a burn scar is an extremely rare occurrence, and there have been no reports of pyogenic granulomas caused by flame and other type of scalding burns such as hot water and oil. The case presented here was a burn injury caused by hot milk. The burn etiology, not the burn injury itself, is important because all similar cases have the same etiology. We thought that this may not be a coincidence and that milk proteins or other components of the milk might cause the development of pyogenic granuloma.
Pyogenic granuloma is a benign vascular, inflammatory proliferation that appears following minor trauma in children. The exact pathogenesis of pyogenic granuloma is unknown, but its formation is closely related to minor trauma, chronic irritation, and hormonal influences. We present a unique case of a pyogenic granuloma that appeared in an infant following circumcision.
Publisher:
Medknow Publications & Media Pvt Ltd
(India
)
ISSN
(Print):
0974-2077
ISSN
(Electronic):
0974-5157
Publication date
(Print):
Apr-Jun 2017
Volume: 10
Issue: 2
Pages: 113-114
Affiliations
[1]Department of Dermatology, Venereology and Leprosy, SBMP Medical College, Hospital
and Research Center, BLDE University, Bijapur, Karnataka, India
Author notes
Address for correspondence: Dr. Arun C Inamadar, Department of Dermatology, Venereology and Leprosy, SBMP Medical
College, Hospital and Research Center, BLDE University, Bijapur - 586 103, Karnataka,
India. E-mail:
aruninamadar@
123456gmail.com
This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non-commercially, as long as the author is credited and the
new creations are licensed under the identical terms.