A Gray-purple Mass on the Floor of the Mouth: Gigantic Mucogingival Pyogenic Granuloma in a Teenage Patient

Abstract

Pyogenic granuloma is defined as a benign neoplasm of vascular phenotype. This case describes the clinical and histopathological features of a gigantic mucogingival pyogenic granuloma, in a 14-year-old healthy black boy. This exophytic gray-purple mass, related to a toothpick injury, had more than twelve-month evolution on the anterior mandible involving lingual area besides to the floor of the mouth pressing the right salivary duct. Conservative excision was performed, followed by uncomplicated healing with no recurrence in two years. The histopathological examination reported a pyogenic granuloma (lobular capillary haemangioma). The authors provide a discussion of the presurgical differential diagnosis of the lesion. This case report presents an extremely uncommon location of a gigantic pyogenic granuloma, involving mucogingival complex and affecting the salivary outflow. This clinical manuscript may shed light on the controversies about possible mechanisms inducing oral pyogenic granuloma.

Keywords: Inflammatory gingival hyperplasia; lobular capillary haemangioma; mucogingival complex; pyogenic granuloma..

Fig. (1)

Clinical intraoral image of the exophytic lesion in relation to lingual area.

Fig. (2)

Clinical intraoral image. The lesion was pedunculated involving the lingual mucogingival line and inserted on the keratinized mucosa.

Fig. (3a)

Macroscopic appearance of the excised lesion. Notice the multilobular base around the pedunculated area. (b). Clinical intraoral image. Notice a light tumefaction evidenced on the right sublingual area, immediately after the mass excision.

Fig. (4a)

Microscopic appearance. Under an ulcerated surface there is an extensive granulation tissue reaction characterized by abundant small size vessels arranged perpendicularly to surface. At the bottom of the image, the characteristic appearance of pyogenic granuloma can be seen on the right (H&E, original magnification 10x). (b). At a higher power, the typical histologic features of pyogenic granuloma consist in a proliferation of capillary sized vessels arranged surrounding larger vessel structures producing its typical lobular distribution. There is stromal fibrosis dissecting between the capillary lobules. (H&E, original magnification 20x).