Pyogenic Granuloma

Pyogenic granuloma represents an over-exuberant tissue reaction to some known stimuli or injuries. The term pyogenic granuloma is somewhat a misnomer since the condition is not associated with pus formation.

CLINICAL FEATURES
Age: occurs at an early age.
Sex: seen more frequently in females.
Site: mostly occurs in relation to the gingiva, however on rare occasions, other mucosal sites may be involved.

PRESENTATION
• The lesion appears as a small, pedunculated or sessile, painless, soft, lobulated growth on the gingiva

• Labial surface of the gingiva is more frequently affected than the lingual surface.

• The lesion is often ulcerated and bleeds profusely, either upon provocation or spontaneously.

• The ulcerated area of the lesion is often covered by a yellow fibrinous membrane.

• The rate of growth of the lesion is very rapid and its maximum size could be up to 1 cm in
diameter

•Untreated lesion of pyogenic granuloma undergoes fibrosis due to decreased vascularity and in such cases it appears small, firm with little tendency to bleed. This lesion is called “fibroepithelial polyp”

• Similar lesions appearing on the gingival tissue of pregnant women are known as “pregnancy tumor”.

HISTOPATHOLOGY 
• Histologically, the lesion is composed of lobular masses of hyperplastic granulation tissue, containing multiple proliferating fibroblasts, many blood capillaries and a variable number of chronic inflammatory cells.

• The lesion is a vascular one and it occurs due to the proliferation of the endothelial cells.

• The overlying epithelium is thin and ulcerated, and in most of the cases the underlying
connective tissue shows intercellular edema.

• Areas of hemorrhage and hemosiderin pigmentation are often seen within the connective tissue stroma.

TREATMENT
Pyogenic granuloma is treated by surgical excision.