The etiology of this disease is not yet fully understood. It has been considered to be a reactive hyperproliferative vascular response to a variety of stimuli, more than a true hemangioma [ 1 , 3 , 4 ]. Recently, the likely explanation for the pathogenesis is an excessive local production of tumor angiogenesis factor, as a result of minor trauma or an underlying cutaneous disease [ 4 ]. PG is a lesion of the skin and mucous membranes and it can be seen in various locations of the body. A year retrospective analysis of 86 cases from Akamatsu et al.
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The skin of the head, neck, upper trunk, and hands and feet and the oral mucosa and gingiva are the most common sites, but it seldom appears on the female genitalia. Case Report: A year-old woman presented with a lobulated lesion on the right labia majora.
The surface of the lesion was reddish and bled occasionally. The lesion was excised and histopathology revealed features suggestive of lobular capillary hemangioma pyogenic granuloma. Conclusion: Pyogenic granuloma is considered a reactive hyperproliferative vascular response to trauma or other stimuli.
There are a few cases of lobular capillary hemangioma of the glans penis but it is rare on the female genitalia. We present this case to help physicians become aware that lobular capillary hemangiomas may occur at this site. The lesion usually occurs in children and young adults on the head, neck, extremities, and upper trunk . Other pyogenic granuloma variants that have been well documented include disseminated, subcutaneous, intravenous, and systemic medication retinoid and protease inhibitor -induced subtypes.
We report a rare case of vulvar lobular capillary hemangioma pyogenic granuloma. Case Report A year-old multiparous woman with no specific medical history presented with a reddish papule on the right labia majora. According to the patient, it bled occasionally on contact with her underwear. However, she did not recall any trauma or injury before she noticed the papule. She visited our gynecology outpatient department due to the malignant appearance of the lesion.
The lesion was excised under intravenous general anesthesia. The epidermis was elevated, hyperkeratotic, and ulcerated. Microscopic examination revealed a polypoid skin lesion lined with hyperkeratotic epidermis. The picture was suggestive of lobular capillary hemangioma. Discussion Pyogenic granuloma is a relatively common skin growth. A literature search revealed a few reports of lobular capillary hemangioma of the glans penis but not on the female genitalia [7—10].
The surface is usually ulcerated and the lesion exhibits a lobular architecture. The precise mechanism for the development of pyogenic granuloma is unknown. Trauma, hormonal influences, viral oncogenes, underlying microscopic arteriovenous malformation, and production of angiogenic factors have been implicated. While trauma was long considered a primary cause, one large study by Patrice et al found that Pyogenic granulomas are always benign.
Although cancer rarely mimics pyogenic granuloma, there is always a concern that the lesions could be cancerous. A sample is usually obtained for biopsy analysis. This is particularly important since Patrice et al reported At times, multiple smaller pyogenic granulomas form following treatment. It appears that pieces of pyogenic granuloma may spread through local blood vessels . Pyogenic granulomas in pregnant women may resolve spontaneously after delivery, and conservative therapy is sometimes the best strategy in those cases.
Laser surgery can also be performed but it has not been proven to be superior . Patrice et al report that full-thickness skin excision closed with stitches appears to yield the lowest chance of recurrence . References 1. Requena L, Sangueza OP. Cutaneous vascular proliferations. Part II. Hyperplasias and benign neoplasms. J Am Acad Dermatol ;— Pyogenic granuloma lobular capillary hemangioma : a clinicopathologic study of cases.
Pediatr Dermatol ;— Clinical diagnosis and management of hormonally responsive oral pregnancy tumor pyogenic granuloma. J Reprod Med ; — A rare sideeffect of systemic isotretinoin treatment: pyogenic granuloma.
J Eur Acad Dermatol Venereol ;— Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes. Am J Surg Pathol ;—9. Pyogenic granuloma of the cornea in an infant with unilateral microphthalmia.
Arch Ophthalmol ;— Multiple pyogenic granuloma of the penis. Sex Transm Infect ;—2. Pyogenic granuloma of the penis: a rare entity? Genitourin Med ;—4. Pyogenic granuloma of the glans penis. Br J Urol ;—2. Summers JL. Pyogenic granuloma: an unusual complication of papaverine injection therapy for impotence. J Urol ; —8. Pyogenic granuloma of the larynx and trachea. A causal and pathologic misnomer for granulation tissue. Arch Otolaryngol ;—2. Eruptive disseminated lobular capillary hemangioma pyogenic granuloma.
J Am Acad Dermatol ;—4. Eruptive pyogenic granulomas: a successfully treated patient and review of the literature. Br J Dermatol ;—6.
A rare mass formation of the vulva: giant cavernous hemangioma.
Vulvar abnormalities have many variations in presentation. Because multiple diagnoses may have similar gross characteristics, histologic evaluation is critical in establishing an accurate diagnosis. Histologic classification based on the tissue of origin is practical in the description of vulvar lesions. The two major categories for vulvar lesions are tumors of epithelial origin and tumors of mesenchymal origin. HPV infections are classified as either clinical or subclinical, contingent on the infectivity of the virus and the response of the affected epithelium. The typical expression is a soft, pink-white, papillary epithelial lesion. These lesions may occur singly or in clusters that may become confluent Fig.
Hemangioma: sintomas, tratamentos e causas