Reactionary Bone Changes in Long-Standing Pyogenic Granuloma: A Case Report

Abstract

Pyogenic granuloma is a reactive lesion that is commonly seen in the skin and oral cavity. Though it is an unfortunate misnomer, being neither pyogenic nor a true granuloma, the name has been used for years. In the oral cavity, it presents as a growth mostly situated on the gingiva, but may also occur on the tongue, buccal and labial mucosa, and palate, and may even be seen in relation to dental implants. The lesion is usually bright or purple red in color, soft in consistency, relatively painless, and appears highly vascularized. Local etiologic factors are usually poor oral hygiene or chronic irritation. Histopathologically it is an inflammatory hyperplasia of the connective tissue with exuberant vascularity. Sometimes, this lesion may present with unusual histopathological patterns, which could lead to difficulty in diagnosis. Long-standing pyogenic granuloma may show histologic changes such as localized osteogenesis in the matrix of the lesion which could potentially lead to complications in the area of the lesion. This article reports a rare case with rare histopathological features in an 18-year-old female presenting with long-standing soft tissue gingival growth.

Keywords: exophytic; osteogenesis; pyogenic granuloma; trabeculae; vascular.

Figure 1. Localized soft tissue growth with 31, 32 region

Figure 2. (a) Excision done on the soft tissue growth. (b) Excised tissue.

Figure 3. Excised tissue placed in formalin solution.

Figure 4. Overlying hyperplastic epithelium and underlying connective tissue stroma comprising numerous blood capillaries and dense inflammatory cell infiltrate with bony trabeculae.