Oral pyogenic granuloma of upper labial mucosa: An unusual case presentation

Headnote

Abstract

This case report intends to highlight the clinical differential diagnosis and dilemma in diagnosing simple mucosal lesions like pyogenic granuloma (PG). PG is a benign and non-neoplastic lesion. It is manifested as a sessile or pedunculated growth, which is resilient, erythematous, exophytic and painful. Seldom it appears as papular or nodular growth with a smooth or the lobulated surface that bleeds easily. PG affects the gingival preferentially but may also occur on the lips, tongue, oral mucosa and palate. This paper presents an unusual case report where PG was present on the upper labial mucosa. The lesion presented as an exophytic growth with history of occasional pain and bleeding on manipulation. On palpation, the growth was pedunculated, soft to firm and asymptomatic with bleeding on manipulation. This case presented as an atypical form of PG, which easily mislead to various differential diagnosis. Bleeding on manipulation was the only positive finding pointing towards PG. This clinical presentation presents a platform to discuss some unusual differential diagnosis of PG like squamous papilloma, mucocele with PG and traumatic eosinophilic granuloma.

Keywords: Mucocele, pyogenic granuloma, squamous papillom

Introduction

Oral pyogenic granuloma (PG) is a benign non-neoplastic lesion. The term "pyogenic" is a misnomer as this condition does not generate any purulent secretion and is unrelated to infection.® PG is also called as pregnancy granuloma or pregnancy tumor when it occurs in pregnant women. It is also known as vascular epulis, benign vascular tumor or hemangiomatous granuloma.®

PG has been defined as an inflammatory overgrowth of the oral mucosa caused by minor trauma or irritation. PG is manifested as a sessile or a pedunculated growth which is erythematous, exophytic, resilient and painful nodule or papule. It presents as a smooth or lobulated surface that bleeds easily. Intra orally, the most commonly affected site is gingiva accounting for 75% of all cases.® Although the occurrence of these lesion on the lips, tongue, oral mucosa, palate and fingers has also been reported. PG affecting the labial mucosa is uncommon.[2]

The vascular effects of hormones are a probable reason for the occurrence of PG with a higher frequency among females in the second decade of life especially.®

Microscopically, PG is characterized by increased vascular proliferation associated with granulation tissue and chronic...