PYOGENIC GRANULOMA

nonneoplastic Unrelated to infection No true granuloma an exuberant tissue response to local irritation or trauma In spite of its name a relatively common reactive, tumorlike growth of oral cavity

Clinical Features a smooth or lobulated mass usually pedunculated, although some lesions are sessile The surface is characteristically ulcerated

ranges from pink to red to purple, depending on the age of the lesioncolor only a few millimeters in to several centimeters in diameter size Typically painless often bleeds easily may exhibit rapid growth gingiva (75%) > lips, tongue, buccal mucosa

some extend between the teeth maxillary gingiva > mandibular gingiva anterior areas > posterior areas facial > lingual

at any age most common in children and young adults

a definite female predilection, pregnancy tumor may begin to develop during the first trimester their incidence increases up through the seventh month of pregnancy

A large lesion arising from the palatal gingiva in association with an orthodontic band. The patient was pregnant.

Hemorrhagic,ulceratedgingival mass pregnant woman

Epulis granulomatosa hyperplastic growths of granulation tissue that sometimes arise in healing extraction sockets a granulation tissue reaction to bony sequestra in the socket Nodular mass of granulation tissue that developed in a recent extraction site

Histopathologic Features a highly vascular proliferation that resembles granulation tissue In healing woundsfibrinfibrin clotfibrous connective tissue granulation tissue

Numerous small and larger endothelium-lined channels Neutrophils ………………………….near the ulcerated surface chronic inflammatory cells ………..deeper in the specimen

capillary blood vessels and scattered inflammation. channels are formed that are engorged with red blood cells

The surface is usually ulcerated and replaced by a thick fibrinopurulent membrane

Older lesions may have areas with a more fibrous appearance. In fact, many gingival fibromas probably represent pyogenic granulomas that have undergone fibrous maturation.

Treatment and Prognosis conservative surgical excision The specimen should be submitted for microscopic examination to rule out other more serious diagnoses. For gingival lesions, the excision should extend down to periosteum the adjacent teeth should be thoroughly scaled to remove any source of continuing irritation Diff.Diagnosis : PGCG Peripheral odontogenic fibroma peripheral ossifying fibroma rarely metastatic cancer

The recurrence rate is higher for pyogenic granulomas removed during pregnancy some lesions will resolve spontaneously after parturition Occasionally, the lesion recurs For pregnanc tumors…. …….usually treatment should be deferred unless significant functional or aesthetic problems develop

The End