Dermatologic Manifestations of Pyogenic Granuloma (Lobular Capillary Hemangioma) Workup

  • Author: Joseph C Pierson, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 29, 2010
 

Procedures

Dermoscopy may be helpful in the recognition of pyogenic granulomas (lobular capillary hemangiomas).[21] A reddish homogeneous area surrounded by a white collarette is found in the majority of cases. Even dermoscopically, pyogenic granuloma may be indistinguishable from a pigmented malignant melanoma.[22]

A specimen for histologic examination may be obtained by shave, punch, scalpel, or laser excision.

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Histologic Findings

The histopathologic findings in all variants of pyogenic granuloma are similar. Early lesions resemble granulation tissue (numerous capillaries and venules with plump endothelial cells arrayed radially toward the skin surface amidst an edematous stroma containing a mixed inflammatory infiltrate). Often, overlying erosive or ulcerative changes are noted. The matured polypoid lesion exhibits a fibromyxoid stroma separating the lesion into lobules. Reepithelialization of the surface and a peripheral hyperplastic adnexal epithelioid collarette may be noted, and less inflammatory infiltrate is present. A regressing pyogenic granuloma displays extensive fibrosis. The intravenous variant has less lobulation and is connected to the wall of a vein by a stalk. Rarely, extramedullary hematopoiesis may be seen histologically within pyogenic granulomas.[23] Endothelial GLUT1 immunohistochemical expression is positive in juvenile hemangioma, but negative in pyogenic granuloma.[24]

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Contributor Information and Disclosures
Author

Joseph C Pierson, MD  Consulting Staff, Department of Dermatology, Guthrie Army Clinic, Ft Drum, NY

Joseph C Pierson, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Christine C Tam, MD  Staff Physician, Dermatology Office of David A Spott, MD

Christine C Tam, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Donald Belsito, MD  Clinical Professor, Department of Internal Medicine, Division of Dermatology, University of Missouri at Kansas City; Private Practice, American Dermatology Associates, LLC

Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, Kansas Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, and Phi Beta Kappa

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Pyogenic granuloma on the neck of the young girl. Courtesy of Jeffrey P. Callen, MD.
Multiple recurrent pyogenic granulomas on the neck of a young girl. Courtesy of Jeffrey P. Callen, MD.
Pyogenic granuloma on the hand. Courtesy of Jeffrey P. Callen, MD.
 
 
 
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