Clinical and endoscopic features of gastric pyogenic granuloma

Lobular capillary hemangioma (pyogenic granuloma) of the gastrointestinal tract: Clinicopathologic analysis of 34 cases

OBJECTIVES

Lobular capillary hemangioma (LCH) rarely involves the gastrointestinal (GI) tract. This study describes clinicopathologic features of LCH in a cohort of GI cases.

METHODS

We defined lobular capillary hemangioma as "a proliferation of capillary-sized blood vessels arranged at least focally in a lobular configuration," searched departmental archives for cases, and recorded clinicopathologic findings.

RESULTS

We identified 34 GI tract LCHs from 16 men and 10 women; 4 patients had multiple lesions. Mean age was 64 years. Cases arose in the esophagus (n = 7), stomach (n = 3), small bowel (n = 7), and colorectum (n = 17). Twelve patients had anemia or rectal bleeding. No patients had a known genetic syndrome. The lesions manifested as mucosal polyps, with median size of 1.3 cm. Microscopically, 20 lesions were ulcerated, and most involved the mucosa, with 9 extending into the submucosa. Vessel dilation was present in 27 patients, endothelial hobnailing in 13, hemorrhage in 13, and focal reactive stromal atypia in 2. Follow-up information was available for 10 patients, none of whom developed same-site recurrence. Six of the 26 cases (23%) were extradepartmental consultations, including 2 of the multifocal cases.

CONCLUSIONS

Gastrointestinal tract LCHs often arise as colorectal polyps. They are typically small but can reach a few centimeters in size and can be multifocal.

A Huge Oropharyngeal Pyogenic Granuloma in a Patient Presenting with Dysphagia

A 39-year-old woman experienced dyspnea and progressive dysphagia for 1 year. Dysphagia appeared for solid foods at the beginning but advanced for liquids. She described 17 kg weight loss in the past 6 months and her current weight was 38 kg [body mass index (BMI) 16 kg/m²]. Dyspnea presented with effort and lying was included after 1 month. There was no disease or surgery except chronic hepatitis C in her medical history. Physical examination revealed hyponasal speech and a mass beside the tongue base. A smoothly surfaced 4 × 3-cm vascular mass in oropharynx was determined in endoscopic examination. The mass was mobile and occupied 80% of oropharyngeal area. Contrast-enhanced computed tomography revealed hypervascular 4 × 4 × 3 cm pedunculated (8 × 13 mm) mass arising from the right tongue base. The mass and the surrounding mucosa with a thin layer of tongue musculature were excised using cold instrumentation and bipolar cautery. Histologically the mass was reported as pyogenic granuloma (PG). This is the first study to report on oropharyngeal PG causing obvious weight loss in literature.

Gastrointestinal Pyogenic Granuloma (Lobular Capillary Hemangioma): An Underrecognized Entity Causing Iron Deficiency Anemia

Pyogenic granuloma (PG), more accurately known as lobular capillary hemangioma, is a benign vascular tumor that usually occurs in the skin or oral mucosa. This lesion is rarely reported in the gastrointestinal tract but is known to bleed if not resected. We herein describe a case series with the clinical, endoscopic, and histologic findings of four cases of gastrointestinal PG at our institution. In addition, we provide a review of the literature and summation of all reported cases of PG specific to the gastrointestinal tract. Based on our experience, we suggest that the actual incidence of gastrointestinal PG may in fact be higher than reported because PG can be unrecognized or improperly diagnosed. It is important for the clinician to properly recognize this lesion as a source of anemia and its propensity to bleed during biopsy or resection.