Pyogenic granuloma of the duodenum treated successfully by endoscopic mucosal resection

Abstract

Pyogenic granuloma is a lobular capillary hemangioma that occurs mostly on the skin and the mucosal surfaces of the oral cavity and tongue. Only a few cases in other parts of the digestive tract have been reported. Gastrointestinal pyogenic granuloma is a rare cause of hemorrhage in the digestive tract, but should be considered in the differential diagnosis of patients with gastrointestinal bleeding. We report the case of a 62-year-old anemic woman found to have a pyogenic granuloma of the duodenum, which was treated adequately by endoscopic mucosal resection.

Keywords: Duodenum; Granuloma; Pyogenic.

Fig. 1

Upper-duodenum endoscopic findings. A 10-mm-diameter semipedunculated strawberry-like lesion with a whitish exudate evident in the second portion of the duodenum.

Fig. 2

Contrast-enhanced abdominal computed tomography showing a 10-mm-diameter strongly enhanced lesion (arrow) in the second portion of the duodenum.

Fig. 3

Endoscopic mucosal resection (EMR). A 10-mm-diameter semipedunculated strawberry-like lesion in the second portion of the duodenum was removed by EMR (injection and snaring method).

Fig. 4

Photomicrograph showing the features of pyogenic granuloma: the polypoid mass shows edematous granulation tissue with proliferation of dilated capillaries and infiltration of inflammatory cells with erosion (A, H&E stain, original magnification ×20; B, H&E stain, original magnification ×100).