Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor - Observation Letter
2020:86:2;197-199
doi: 10.4103/ijdvl.IJDVL_142_19
PMID: 31929230

Linear papular pyogenic granuloma: An unusual presentation

Chandra Sekhar Sirka, Arpita Nibedita Rout, Kananbala Sahu
 Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Correspondence Address:
Arpita Nibedita Rout
Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha
India
Published: 08-Jan-2020
How to cite this article:
Sirka CS, Rout AN, Sahu K. Linear papular pyogenic granuloma: An unusual presentation. Indian J Dermatol Venereol Leprol 2020;86:197-199
Copyright: (C)2020 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Pyogenic granulomas are benign, reactive, typically superficial vascular lesions that can be idiopathic or arise secondary to trauma, underlying vascular malformations, infections, physiologic or pathologic endocrine changes, and hormone therapy.[1] Rarely, subcutaneous and intravascular lesions have been described in literature. Most cases occur as solitary lesions; but multiple, grouped and disseminated lesions have been described.[2] Papular lesions in a linear distribution have never been reported. The diagnosis of pyogenic granuloma is confirmed by histology.

A 57-year-old male presented with multiple asymptomatic nodules over the left-side forehead and eyebrow since the past 5 years. These lesions were increasing in number with appearance of new nodules at 2–3 months interval. He was diagnosed to have hepatocellular carcinoma 10 years back, which had completely resolved after chemotherapy. On clinical examination, there were multiple skin-colored to slightly erythematous soft nontender sessile, mobile growths in groups with a linear distribution over the left-side forehead, left eyebrow, and left upper eyelid [Figure - 1]. There was no preceding history of prolonged drug intake or trauma prior to the appearance of the lesions or any history of bleeding from the site. There was no other significant cutaneous or systemic findings. Based on the history and clinical examination, benign vascular tumor and metastatic hepatocellular carcinoma were considered as differential diagnosis. The dermoscopic examination showed white areas in the center with surrounding rim of red circles and telangiectasias, suggestive of a vascular tumor. Hence, a clinical possibility of vascular tumor was considered. Routine investigations such as complete hemogram, liver, and renal function tests were within normal limits. Doppler ultrasonographic examination showed no intra-orbital or intracranial extensions. On histopathological examination, there were lobules of proliferating capillaries lined by single layer of endothelial cells separated by fibrous strands in the mid dermis level without any change in the epidermis [Figure - 2] and [Figure - 3]. Thus, a final diagnosis of pyogenic granuloma was made. The patient was treated with excision and cauterisation of the lesion. He was followed up for 6 months with no recurrence.

Figure 1: Multiple skin-colored to erythematous papules nodules in a linear pattern over the left forehead and eyebrow
Figure 2: Histopathology of the lesion showing lobulated vascular mass in mid and lower dermis, with intervening fibrous septa (H and E, 40×)
Figure 3: High-power view showing thin-walled capillaries (H and E, ×400)

Lobular capillary hemangioma or pyogenic granuloma is a common benign vascular proliferation. Typically, these lesions occur in the superficial dermis; although rare, subcutaneous and intravascular lesions can occur.[3] Clinically, the lesions are described as painless skin-colored to erythematous papules and nodules, with few of them showing surface erosion. Our patient had multiple soft nontender skin-colored to erythematous papules and nodular growths present in grouped pattern over the left side of the forehead, left eyebrow, and upper eyelid, but the linear distribution of the lesions in our case is unusual.

Dermoscopy of pyogenic granuloma shows homogeneous reddish or white-red areas(proliferating capillaries and veins) surrounded by whitish collarette(surrounding epidermal collarette in histopathology). An atypical dermoscopic pattern characterized by the presence of a central, irregular, whitish-yellow amorphous structure with a peripheral crown of polymorphous, atypical vessels has also been reported. Our case had central white areas and rim of reddish areas. Diagnosis is by histopathologic examination which shows immature capillaries with interspersed fibroblastic tissue, resembling granulation tissue in an edematous matrix. The deeper portion of the lesion has proliferating capillaries arranged in a lobular pattern extending into the deep dermis, with a dense, fibrous stroma.[4] Our patient had thin-walled capillaries in the deeper dermis with intervening fibrous stroma. Pyogenic granuloma has to be differentiated from tufted angioma histopathologically. In case of tufted angioma, the endothelial cells are plump and the lumen is usually obliterated, with lobules composed of bloodless capillaries surrounded by dilated crescent-shaped vascular channels. The angiomatous tissue in pyogenic granuloma is composed of dilated network of blood-filled capillaries and groups of poorly canalized vascular tufts surrounded by myxoid stroma.

Numerous treatment methods have been described for pyogenic granuloma: curettage, shave excision, laser therapy, or excision. Because the lesion can involve the reticular dermis, it may be out of the reach of the pulsed-dye laser, cautery, or shave excision. Definitive management requires full-thickness skin excision.[5] Localized recurrence after excision and satellite spread of the lesions is known. Our patient opted for surgical excision for cosmetic purpose, and there was no recurrence after the procedure.

Our patient had asymptomatic soft grouped papulonodules with linear distribution. Dermoscopy showed vascular nature of the lesion. Histopathology proved the diagnosis to be pyogenic granuloma. We report this case for its unique linear pattern of distribution.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Putra J, Rymeski B, Merrow AC, Dasgupta R, Gupta A. Four cases of pediatric deep-seated/subcutaneous pyogenic granuloma: Review of literature and differential diagnosis. J Cutan Pathol 2017;44:516-22.
[Google Scholar]
2.
Wollina U, Langner D, França K, Gianfaldoni S, Lotti T, Tchernev G. Pyogenic granuloma – A common benign vascular tumor with variable clinical presentation: New findings and treatment options. Open Access Maced J Med Sci 2017;5:423-6.
[Google Scholar]
3.
Lee N, Isenstein A, Zedek D, Morrell DS. A case of childhood subcutaneous pyogenic granuloma (lobular capillary hemangioma). Clin Pediatr (Phila) 2012;51:88-90.
[Google Scholar]
4.
Patrice SJ, Wiss K, Mulliken JB. Pyogenic granuloma (lobular capillary hemangioma): A clinicopathologic study of 178 cases. Pediatr Dermatol 1991;8:267-76.
[Google Scholar]
5.
Greene AK. Management of hemangiomas and other vascular tumors. Clin Plast Surg 2011;38:45-63.
[Google Scholar]

Fulltext Views
786

PDF downloads
450
Show Sections