Pyogenic Granuloma (Lobular Capillary Hemangioma) Workup

Updated: Feb 21, 2020
  • Author: Joseph C Pierson, MD; Chief Editor: William D James, MD  more...
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Imaging Studies

Sonographic features of digital subcutaneous pyogenic granulomas have been described. [56] Subcutaneous pyogenic granuloma sonography and computed tomography findings have also been reported. [57]



Dermoscopy patterns for pyogenic granuloma have been described. [58] A dermoscopic rainbow pattern has been reported. [59] Even dermoscopically, pyogenic granulomas may be indistinguishable from malignant melanoma. [60]

Reflectance confocal microscopic findings of solitary red nodules, including pyogenic granuloma, have been published. [61]

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


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.

Extramedullary hematopoiesis is seen histologically in 10% of pyogenic granulomas. [62] Wilms tumor 1 protein expression is positive in vascular proliferations such as pyogenic granuloma. [63] Endothelial GLUT1 immunohistochemical expression is positive in infantile hemangioma, but negative in pyogenic granuloma. [64]

The intravenous variant has less lobulation and is connected to the wall of a vein by a stalk.