Lobular capillary hemangioma, also known as pyogenic granuloma, is a tumor-like, benign reactive, vascular proliferation, essentially an "-oma" of granulation tissue, usually caused by trauma or local irritation. It is not a true neoplastic process. It does not usually suppurate so the term "pyogenic" is a misnomer.
It tends to occur in children and young adults, and 75% occur on the gingiva. However, the labial mucosa, buccal mucosa, and tongue may also be affected. Over time, lobular capillary hemangiomas may sclerose and become more fibrous.
A particular subset occurs in pregnant patients, and this is called "granuloma gravidarum." These occur in the first trimester of pregnancy and grow steady under hormonal influences throughout pregnancy. Postpartum, the lesions tend to become smaller or involute completely. However, many will remain as a smaller, scarred, fibrotic nodule. Patients are aware of an enlarging mass that may bleed easily.
Lobular capillary hemangioma - Oral Mucosal Lesion
See also in: Overview,External and Internal Eye,Hair and Scalp,Nail and Distal DigitAlerts and Notices
Synopsis
Codes
ICD10CM:
L98.0 – Pyogenic granuloma
SNOMEDCT:
200722003 – Pyogenic granuloma
L98.0 – Pyogenic granuloma
SNOMEDCT:
200722003 – Pyogenic granuloma
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Peripheral giant cell granuloma also occurs on the gingiva and has a similar appearance.
- A varix with or without thrombosis may appear similar clinically.
- Hemangioma is clinically indistinguishable.
- Hematoma develops very rapidly and resolves within days.
- Kaposi sarcoma tends to occur in patients with HIV infection or AIDS, or Kaposi sarcoma, non-AIDS.
- Some abscesses on the gingiva also appear purplish and vascular and develop rapidly. They are always painful and associated with an odontogenic infection.
- Angina bullosa hemorrhagica is an uncommon condition where blood blisters form very rapidly.
- Metastatic tumors often involve the gingiva, but these generally occur in older patients. Metastatic renal cell carcinomas in particular are quite vascular and may appear as purplish red nodules.
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Updated:05/08/2023
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Lobular capillary hemangioma - Oral Mucosal Lesion
See also in: Overview,External and Internal Eye,Hair and Scalp,Nail and Distal Digit