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      Lobular Capillary Hemangioma Masquerading as Pyogenic Granuloma of Anterior Mandible: A Case Report

      case-report
      1 , 1 , 1 , 2 , 1 ,
      ,
      Cureus
      Cureus
      lch, recurrent, pyogenic granuloma, gingiva, lobular capillary hemangioma

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          Abstract

          Pyogenic granuloma (PG) is a reactive connective tissue disorder with female predilection, which exhibits a tumor-like mass with occasional bleeding and superficial ulceration. It most commonly occurs in the maxillary gingiva followed by the mandibular gingiva. It can also occur in extra gingival sites like buccal mucosa, labial mucosa, and palate. There are two histopathological types of PG, namely, a lobular capillary hemangioma (LCH) variant and a non-LCH variant.

          The various management methods include surgical resection or laser excision along with deep curettage, and there are various nonsurgical methods like local steroid injection, topical administration of various drugs, and sclerotherapy. During the surgical excision, there is a risk of bleeding, and the surgeon should be equipped for the same. The PG (both LCH and non-LCH variant) has an increased chance of recurrence because of which complete excision is mandatory along with the removal of the local irritants.

          In this case report, a 28-year-old female patient reported recurrent painless swelling in the lower front gums for the past nine months.

          The surgical excision was done in-toto along with the removal of local irritants (calculus). The swelling was sent for histopathological examination. The patient was kept on regular follow-ups.

          The patient was followed up continuously for nine months. The swelling did not recur after the excision.

          Hence, it was concluded that complete excision and removal of local irritants are extremely crucial to prevent a recurrence.

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          Oral pyogenic granuloma: Various concepts of etiopathogenesis

          Pyogenic granuloma or granuloma pyogenicum is a well-known oral lesion. The name pyogenic granuloma is a misnomer since the condition is not associated with pus and does not represent a granuloma histologically. Pyogenic granuloma of the oral cavity is known to involve the gingiva commonly. Extragingivally, it can occur on the lips, tongue, buccal mucosa, palate, and the like. A history of trauma is common in such sites. The etiology of the lesion is not known, though it was originally believed to be a botryomycotic infection. It is theorized that pyogenic granuloma possibly originates as a response of tissues to minor trauma and/or chronic irritation, thus opening a pathway for invasion of nonspecific microorganisms, although microorganisms are seldom demonstrated within the lesion. Pathogenesis of pyogenic granuloma is still debatable. Medline and PubMed databases were searched under the following key terms: Pathogenesis of oral pyogenic granuloma, pyogenic granuloma, and oral pyogenic granuloma. This search was limited to articles on human/animal studies which were published in English language. After reviewing the searched articles, the relevant articles were selected for the present review. Through this article, we have tried to summarize and present all the concepts of pathogenesis related to this most common and most mysterious oral lesion.
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            Oral pyogenic granuloma: a retrospective analysis of 293 cases in a Brazilian population.

            The purpose of this study was to retrospectively analyze the clinical, demographic, and pathologic properties of oral pyogenic granuloma occurring in a Brazilian population. We retrieved an archival number of 293 cases that were diagnosed as having oral pyogenic granuloma at the Service of Pathological Anatomy, Discipline of Oral Pathology, Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Brazil, during a 38-year period, from 1970 to 2008. The records were reviewed, and information on gender, age, race, lesion site, predisposing factors, clinical features, and clinical diagnosis, treatment, and recurrence was collected. There was a female predilection, and the female-to-male ratio was 2.38:1. The mean age of the patients was 27 years. A high degree of occurrence was observed in the second decade of life. White patients were most commonly affected (44.7%). The most frequently involved site was the gingiva (83%), with a higher prevalence in the maxilla. The majority of cases were symptomatic and showed bleeding; the lesions were described as nodules (71.9%) with a soft consistency (62.3%) and a red surface (73.2%). The base was pedunculated in 61.1% of cases, and the mean size was 1.3 cm. The recurrence rate was 8.2% of cases. The clinical, demographic, and pathologic features of oral pyogenic granuloma in the Brazilian population in this study were similar to those in studies of populations from other countries. Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
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              Pyogenic granuloma of the oral cavity: comparative study of its clinicopathological and immunohistochemical features.

              There are two histological types of pyogenic granuloma (PG) of the oral cavity: the lobular capillary hemangioma (LCH) and non-LCH type. The aim of the present study was to examine and compare the clinical features, etiological factors, diameter of vascular elements and immunohistochemical features of LCH and non-LCH histological types of PG to determine whether they are two distinct entities. Thirty cases of LCH and 26 cases of non-LCH PG were retrieved and retrospectively studied. Clinically, LCH PG occurred more frequently (66.4%) as sessile lesion whereas non-LCH PG occurred as pedunculated (77%). Non-LCH PG was associated more frequently (86.4%) with etiological factors. The lobular area of the LCH PG contained a greater number of blood vessels with small luminal diameter than did the central area of non-LCH PG. In the central area of non-LCH PG a significantly greater number of vessels with perivascular mesenchymal cells non-reactive for alpha-smooth muscle actin and muscle-specific actin was present than in the lobular area of LCH PG. The differences found in the present study suggest that the two histological types of PG represent distinct entities.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                19 July 2023
                July 2023
                : 15
                : 7
                : e42157
                Affiliations
                [1 ] Oral and Maxillofacial Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
                [2 ] Craniomaxillofacial Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
                Author notes
                Article
                10.7759/cureus.42157
                10439000
                37602023
                d3038c92-5b93-4b72-b3f2-d54fe14ada1c
                Copyright © 2023, Srinivedha et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 July 2023
                Categories
                Trauma
                Dentistry

                lch,recurrent,pyogenic granuloma,gingiva,lobular capillary hemangioma

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