Correspondence Address:
Nitin D Chaudhari
43, Yashshree Society, Near MIT College, Paud Road, Pune - 411 038
India

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Sir,

Pyogenic granuloma or granuloma pyogenicum is one of the most common benign tumor-like proliferation. It is a misnomer being neither associated with pus nor a granuloma histologically. Pyogenic granuloma of the oral cavity commonly involves the gingiva. Extragingivally, it can rarely occur on the lips, tongue and buccal mucosa. [1] The etiology of the lesion is not known, though it was originally believed to be a botryomycotic infection. Pyogenic granuloma possibly originates as a response of tissues to minor trauma and/or chronic irritation and thereby possible invasion by nonspecific microorganisms, although cultured rarely from within the lesion. [2] Herein, we report a case of large pedunculated pyogenic granuloma on an extragingival site in the oral cavity.

A 45-year-old female presented to us with complaints of an asymptomatic growth over the mucosal surface of the lower lip since 2 months. The lesion started as a small red papule,which gradually increased to the present size. Personal and family history was non-contributory. There was history of application of mishry (preparation of tobacco) since many years over the mucosal aspect of lower lip. Examination of lower lip revealed a solitary well-defined, non-tender, smooth pedunculated, non-ulcerated, pink mass measuring 2 cm × 2 cm over its mucosal surface [Figure 1]. She was asymptomatic except for the discomfort due to the presence of growth. Physical examination revealed no lymphadenopathy or any other abnormality. Keeping oral florid papillomatosis, angiosarcoma and Kaposi sarcoma as differential diagnoses, histopathology of the excision biopsy was done, which revealed polypoid mass of angiomatous tissue protruding above the surrounding skin [Figure 2]a. On magnification, stratified squamous orthokeratinized epithelium covering cellular connective tissue was seen.Distinctive lobules of dilated and congested capillaries in an edematous dermal stroma were present [Figure 2]b.{Figure 1}{Figure 2}

Pyogenic granuloma of the oral cavity is a relatively common entity first described by Poncet and Dor in 1897 as "human botryomycosis."The name "pyogenic granuloma" was first given by Hartzell in 1904. [3] Pyogenic granulomas commonly occur on the gingiva, often in the anterior segment of the maxillary jaw. It may also very rarely occur on the alveolar mucosa of edentulous ridge, the palate, and the lower lip. Clinically, they are smooth or lobulated exophytic lesions manifesting as small, red erythematous papules on a sessile or sometimes pedunculated base. The size varies in diameter from few millimetres to several centimetres, rarely exceeding 2.5 cm. The surface is characteristically ulcerated and friable, which may be covered by a yellow, fibrinous membrane and its color ranges from pink to red to purple. [4] Pyogenic granuloma is usually considered to be a reactive tumor-like lesion in response to various stimuli such as chronic low-grade local irritation, trauma, hormonal factors, and drugs, such as cyclosporine. Differential diagnoses include peripheral giant cell granuloma, peripheral ossifying granuloma, metastases of malignant tumors, hemangioma, inflammatory gingival hyperplasia, Kaposi sarcoma, angiosarcoma, non-Hodgkin's lymphoma. Pyogenic granuloma is treated by surgical excision and avoidance of its most common etiology, i.e. trauma or chronic irritation. Other forms of treatment such as Nd: YAG (neodymium-doped yttrium aluminum garnet; Nd: Y 3 Al 5 O 12 ) laser, flash lamp pulsed dye laser, cryosurgery, intralesional injection of ethanol or corticosteroid, and sodium tetradecyl sulphate sclerotherapy have also been proposed. [5]

This case is reported with the aim to arouse awareness in the general practitioners about one of the most common benign growths of the oral cavity.

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