Pyogenic Granuloma
A 45-year-old woman with type 2 diabetes presented to the plastic surgery clinic with a 6-week history of a painless upper-lip lesion. The lesion had rapidly increased in size over the previous 3 weeks and bled when lightly touched. The patient was not pregnant. On physical examination, the lesion was found to be an erythematous, round, smooth, pedunculated mass (Panel A). It was friable but not tender to touch. Histopathological examination of an excisional biopsy specimen showed proliferating vessels, fibroblasts, numerous inflammatory cells, and surface ulceration, findings consistent with pyogenic granuloma (Panel B). Pyogenic granulomas — also known as lobular capillary hemangiomas — are benign, rapidly growing vascular tumors that may occur at sites of frequent trauma, such as the lips, gingiva, and fingers. Contrary to what the name suggests, neither pus nor granulomatous tissue is associated with these lesions. Bleeding is common and is often the presenting symptom. The lesions are typically excised to address the bleeding, ulceration, or cosmetic appearance. At a 4-month follow-up visit, the lesion had not recurred. David Komakech, M.B., Ch.B. Saint Mary’s Hospital Lacor, Gulu, Uganda source: nejm.org