Multiple or Disseminated Pyogenic Granulomata? A Complex Presentation in a Nine-Year-Old Boy

Pyogenic granuloma is a relatively common benign lesion of the skin and/or mucosal surfaces, accounting for 0.5% of all skin nodules in children in the United States alone (Lin et al, 2004). The aetiology is still poorly understood but trauma, hormonal influence, viral oncogenes, microscopic arteriovenous malformations and growth factors (e.g. tumour angiogenesis factor – Patrice et al, 1991) have all been implicated in the pathogenic process (Yuan et al, 2004). What is clear is that the term “pyogenic granuloma” is misleading because it implies a granulomatous inflammation or an infected lesion, neither of which are the case. The “granuloma’s” are thought to result from chronic irritation or trauma, which stimulates excessive capillary proliferation (Requena et al, 1997) and the histological term lobular capillary hemangioma better describes their true nature. Lesions classically present as red nodules, but may appear exophytic with surface crusting or ulceration. Dermal lesions are most commonly found in younger age groups (mean age of presentation 6.7years Pagliai et al, 2004). Most pyogenic granuloma’s are solitary lesions, skin lesions being bright red, shiny papules between a few millimetres in size (average 6.5mm) up to several centimetres. Oral pyogenic granuloma’s classically present during pregnancy as “epulides” arising between the teeth in the inter-dental papilla region (Fig 1). Other forms include: Multiple or Disseminated Pyogenic Granulomata? A Complex Presentation in a Nine-Year-Old Boy