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Patient Case: Pyogenic Granuloma

Patient Case: Pyogenic Granuloma

Discussion

A 34-year-old woman presents to a dermatology clinic with a rapidly growing, red, dome-shaped lesion on her right index finger. She first noticed the lesion three weeks ago after a minor cut while cooking. Over time, it has enlarged to about 1 cm in diameter, frequently bleeds with minor trauma, and has a moist, friable surface. The lesion is painless but causes discomfort due to recurrent bleeding. She denies any history of systemic illness, fever, or recent infections.

On examination, a well-circumscribed, erythematous, vascular papule is seen on the dorsal aspect of the right index finger, with a smooth, lobulated surface. There are no signs of infection or systemic involvement.

Clinical Impression:

The findings suggest a pyogenic granuloma, a benign vascular proliferation often triggered by trauma or irritation.

Questions
  1. What is the most likely cause of the lesion described in this patient?
    a) Viral infection
    b) Bacterial abscess
    c) Trauma-induced vascular proliferation
    d) Autoimmune reaction
  2. Which of the following is the most appropriate treatment option for this patient?
    a) High-dose systemic antibiotics
    b) Surgical excision or curettage with cauterization
    c) Topical antifungal cream
    d) Oral corticosteroids
  3. Which histological feature is characteristic of pyogenic granuloma?
    a) Acantholysis and intraepidermal vesicles
    b) Proliferation of capillaries with a lobular arrangement
    c) Keratin-filled cyst lined by squamous epithelium
    d) Granulomatous inflammation with caseous necrosis
  4. What is a common complication associated with pyogenic granuloma?
    a) Malignant transformation
    b) Spontaneous regression without recurrence
    c) Recurrent bleeding and regrowth after incomplete removal
    d) Systemic dissemination leading to sepsis
Reveal answers

Answers

  1. c) Trauma-induced vascular proliferation
    • Pyogenic granuloma commonly arises after minor trauma, leading to an overgrowth of vascular tissue. It is not caused by viral or bacterial infections.
  2. b) Surgical excision or curettage with cauterization
    • The best treatment involves complete removal, either by excision or curettage, with cauterization to prevent recurrence. Antibiotics and antifungals are ineffective.
  3. b) Proliferation of capillaries with a lobular arrangement
    • Histologically, pyogenic granulomas show lobular clusters of capillaries surrounded by inflammatory cells. This helps differentiate it from other lesions.
  4. c) Recurrent bleeding and regrowth after incomplete removal
    • If not completely removed, pyogenic granulomas often recur, and their fragile nature makes them prone to frequent bleeding.