“Pyogenic granuloma”的意思、由来-开放百科全书

Pyogenic granulomas may be seen at any age, and are more common in females than males. In pregnant women, lesions may occur in the first trimester with an increasing incidence up until the seventh month, and are often seen on the gums.

Signs and symptoms

Clinical presentation

The appearance of pyogenic granuloma is usually a color ranging from red/pink to purple, grow rapidly, and can be smooth or mushroom-shaped. Younger lesions are more likely to be red because of the high number of blood vessels. Older lesions begin to change into a pink color. Size commonly ranges from a few millimeters to centimeters, though smaller or larger lesions may occur.{{medical citation needed|date=August 2013}} A pyogenic granuloma can be painful, especially if located in an area of the body where it is constantly disturbed. Pyogenic granulomas can grow rapidly and will often bleed profusely with little or no trauma. They may exude an oil like substance, causing the surface to be damp. This is especially true if the granuloma is located on the scalp.{{medical citation needed|date=August 2013}}

Epulis granulomatosum is a variant of pyogenic granuloma that forms only on gingiva, and is often seen forming in a recent extraction socket. Pyogenic granulomas appear on the gingiva in 75% of cases, more often in the maxillary than mandibular jaw. Anterior areas are more often affected than posterior areas. It can also be found on the lips, tongue, and inner cheek. Poor oral hygiene or trauma are usually precipitating factors.

One study has suggested a correlation between pyogenic granulomas and Bartonella seropositivity.^[6] However, this association has been questioned by others.^[7] The microscopic appearance of a pyogenic granuloma consists of highly vascular granulation tissue. Inflammation is present. The lesion may have a fibrous character if it is older, and the surface may have ulcerations. Pyogenic granulomas rarely occur in the conjunctiva, cornea or connective tissue of the eye following minor local trauma. Grossly these mass lesions resemble those occurring at more common sites. The relationship of these lesion to lobular capillary hemangiomas of skin and oropharyngeal mucosa commonly referred to as pyogenic granuloma is uncertain.{{citation needed|date=April 2017}}

Associated conditions

Due to its overwhelming incidence on the gingiva, the condition is often associated with two other diseases, though not because they occur together. Instead, the three are associated with each other because they appear frequently on gingiva—peripheral giant cell granuloma and peripheral ossifying fibroma. Detailed analysis can be used to distinguish these conditions.^[8]

Cause

Pyogenic granulomas are caused by proliferation of capillaries and are not caused by infection or cancer.

Diagnosis

History typically involves 25 year old female with a nodular ulcer with discharge over the lip.

Your doctor will likely be able to diagnose a pyogenic granuloma based on its appearance. Your doctor might do a biopsy to make a more accurate diagnosis. This procedure involves taking a tissue sample. A biopsy also helps rule out malignant (cancerous) medical conditions that can cause a similar kind of growth. These conditions include squamous cell carcinoma, basal cell carcinoma, and melanoma.

Histopathological examination shows multiple capillaries(due to the vascular nature of the tumour), neutrophils( pyogenic) and necrotic tissue.

Management

Although pyogenic granulomas are not infectious or malignant, treatment may be considered because of bleeding or ulceration. Frequently, pyogenic granulomas are treated with electrodesiccation (cauterization) and curettage (excision), though laser treatment using pulsed dye laser or CO₂ laser is often effective.^[9]^[10]

Several reports have demonstrated the efficacy of topical application of the beta-adrenergic antagonist timolol in the treatment of pediatric pyogenic granuloma.^[11]

There is usually no treatment if the pyogenic granuloma occurs during pregnancy since the lesion may heal spontaneously. Recurrent bleeding in either oral or nasal lesions may necessitate excision and cauterization sooner, however. If aesthetics are a concern, then treatment may be pursued as well. Usually, only minor surgery may be needed, along with a dental cleaning for oral lesions to remove any calculus or other source of irritation. For nasal lesions, nose-picking should be discouraged.

Prognosis

Prognosis is usually good, however recurrence may happen with rate up to 16%. Presence of myxoid structures in the pyogenic granuloma may be the main cause of recurrence.^[12]

History and terminology

Pyogenic granulomas were first described in 1897 by two French surgeons, Antonin Poncet and Dor, who named these lesions botryomycosis hominis.^[13]

The name pyogenic granuloma is misleading as it is not a true granuloma. In actuality, it is a capillary hemangioma of lobular subtype, which is why such a lesion is prone to bleeding.^[4] Additionally, it is also not truly pyogenic (pus-producing), as the cause is hormonal or traumatic and has no association with infection or pus production.

Gallery

See also

References

1. ^{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: Clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |pages= |isbn=0-7216-2921-0 |oclc= |doi= |accessdate=|display-authors=etal}}
2. ^{{cite book |author1=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}
3. ^Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. {{ISBN|0-07-138076-0}}.
4. ^¹{{cite journal |vauthors=Jafarzadeh H, Sanatkhani M, Mohtasham N | title = Oral pyogenic granuloma: a review | journal = J Oral Sci | volume = 48 | issue = 4 | pages = 167–75 |date=December 2006 | pmid = 17220613 | doi = 10.2334/josnusd.48.167| url = http://joi.jlc.jst.go.jp/JST.JSTAGE/josnusd/48.167?from=PubMed| accessdate = 2009-01-04 | format = – ^{[https://scholar.google.co.uk/scholar?hl=en&lr=&q=intitle%3AOral+pyogenic+granuloma%3A+a+review&as_publication=J+Oral+Sci&as_ylo=2006&as_yhi=2006&btnG=Search Scholar search]}}} {{dead link|date=March 2009}}
5. ^{{cite journal |author=Nthumba PM |title=Giant pyogenic granuloma of the thigh: a case report |journal=J Med Case Reports |volume=2 |issue= 1|pages=95 |year=2008 |pmid=18377654 |pmc=2329656 |doi=10.1186/1752-1947-2-95 |url=http://www.jmedicalcasereports.com/content/2//95}}
6. ^{{cite journal |vauthors=Lee J, Lynde C |title=Pyogenic granuloma: pyogenic again? Association between pyogenic granuloma and Bartonella |journal=J Cutan Med Surg |volume=5 |issue=6 |pages=467–70 |year=2001 |pmid=11907853 |doi=10.1007/s10227-001-0022-0}}
7. ^{{cite journal |vauthors=Levy I, Rolain JM, Lepidi H, etal |title=Is pyogenic granuloma associated with Bartonella infection? |journal=J. Am. Acad. Dermatol. |volume=53 |issue=6 |pages=1065–6 |date=December 2005 |pmid=16310070 |doi=10.1016/j.jaad.2005.08.046 |url=http://linkinghub.elsevier.com/retrieve/pii/S0190-9622(05)02699-X}}
8. ^{{cite journal |vauthors=Salum FG, Yurgel LS, Cherubini K, De Figueiredo MA, Medeiros IC, Nicola FS |title=Pyogenic granuloma, peripheral giant cell granuloma and peripheral ossifying fibroma: retrospective analysis of 138 cases |journal=Minerva Stomatol |volume=57 |issue=5 |pages=227–32 |date=May 2008 |pmid=18496485 |doi= |url=}}
9. ^Pagliai KA, Cohen BA. Pyogenic granuloma in children. Pediatr Dermatol. 2004;21(1):10.
10. ^Tay YK, Weston WL, Morelli JG. Treatment of pyogenic granuloma in children with the flashlamp-pumped pulsed dye laser. Pediatrics. 1997;99(3):368.
11. ^Wine Lee L, Goff KL, Lam JM, Low DW, Yan AC, Castelo-Soccio L. Treatment of pediatric pyogenic granulomas using B-adrenergic receptor antagonists. Pediatr Dermatol. 2014 Mar;31(2)203–7.
12. ^{{cite journal|last1=Al-shiaty|first1=RA|last2=Ottoman|first2=BAE|title=Recurrent pyogenic granuloma: an update|journal=International journal of scientific reports|date=May 2015|volume=1|issue=1|pages=22–31|url=http://www.sci-rep.com/index.php/scirep/article/view/8|doi=10.18203/issn.2454-2156.intjscirep20150196}}
13. ^Ferry AP, Zimmerman LE. Granuloma pyogenicum of limbus. Arch Ophthalmol 74:229–230, 1965.