Journal of Interdisciplinary Dentistry

SHORT COMMUNICATION
Year
: 2012  |  Volume : 2  |  Issue : 3  |  Page : 218--220

Capillary hemangioma of gingiva mimicking as pyogenic granuloma: Report of two cases


M Jananni1, U Gubernath1, Jaideep Mahendra1, M Sivaramakrishnan2,  
1 Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai, India
2 Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College and Hospital, Chennai, India

Correspondence Address:
M Jananni
Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai
India

Abstract

Capillary hemangioma is benign proliferation of blood vessels that primarily occurs during childhood. Pyogenic granuloma is a common benign lesion often found in oral cavity. Pyogenic granuloma is known to show a striking predilection for the gingiva and capillary hemangioma frequently occurs in the lips, cheek, and tongue. The gingival occurrence of capillary hemangioma is considered relatively rare. The purpose of this article is to report two unusual cases of benign tumor occurring on the gingiva which was clinically diagnosed as pyogenic granuloma and histopathologically as capillary hemangioma. Clinical Relevance to Interdisciplinary Dentistry
  • The clinical diagnosis of such an uncommon occurrence can be quite challenging as they sometimes may mimic benign as pyogenic granuloma
  • In reality, it could be a more serious lesion such as malignancies.
Dentists should therefore be aware of these lesions when making diagnosis and attempts at excision of apparently innocent lesions may result in serious bleeding.



How to cite this article:
Jananni M, Gubernath U, Mahendra J, Sivaramakrishnan M. Capillary hemangioma of gingiva mimicking as pyogenic granuloma: Report of two cases.J Interdiscip Dentistry 2012;2:218-220


How to cite this URL:
Jananni M, Gubernath U, Mahendra J, Sivaramakrishnan M. Capillary hemangioma of gingiva mimicking as pyogenic granuloma: Report of two cases. J Interdiscip Dentistry [serial online] 2012 [cited 2022 Sep 25 ];2:218-220
Available from: https://www.jidonline.com/text.asp?2012/2/3/218/113268


Full Text

 Introduction



Hemangioma is a term that encompasses vascular lesions that have similar histological features. [1] It is the most common benign oral soft tissue tumor in children. Although it is considered one of the common soft tissue tumors of the head and neck, it is relatively rare in oral cavity. Capillary hemangiomas are composed of many small capillaries lined with a single layer of endothelial cells supported in connective tissue stroma of varying density. [2],[3]

 Case Reports



A 24-year-old male patient reported with chief complaint of tissue growth in relation to 42 and 43. Clinical examination revealed a single sessile mass on the gingiva in relation to 42 and 43 [Figure 1]a, b. The surface was nodular and erythematous. No bleeding, scar, or sinus tract was evident. On palpation the swelling was afebrile non-tender and soft. The patient's medical history was non-contributory. Taking all clinical findings into consideration, a provisional diagnosis of pyogenic granuloma was made.{Figure 1}

A 50-year-old female patient reported with a chief complaint of growth in the edentulous ridge in relation to 31 for past 3 months [Figure 2]a, b. History revealed trauma in 31 six months back and the tooth was extracted three months back. Intraoral examination revealed a single, sessile, nodular, erythematous, oval growth with white patches. On palpation, the growth was firm and resilient. Blanching and slight bleeding was evident. No discharge was seen. A provisional diagnosis of pyogenic granuloma was made.{Figure 2}

 Surgical Management



For both the cases, oral prophylaxis and excisional biopsy of the lesion was performed under strict aseptic conditions. A 1 mm narrow margin of normal mucosa was removed with the lesion in order to ensure total removal of the lesion and to prevent recurrence [Figure 1]c and [Figure 2]c. Thorough curettage was done and complete hemostasis achieved. The patients were recalled after 1 week and the healing was uneventful and satisfactory. After 1 year, the sites looked completely normal and there was no recurrence [Figure 1]e and [Figure 2]e.

 Histologic Findings



The H and E staining showed parakeratinized stratified squamous epithelium associated with fibrovascular connective tissue. Few areas of epithelium show ulceration and replacement by fibropurulent membrane. The underlying connective tissue showed dense, irregularly arranged collagen fibers. Many small capillary with areas of marked endothelial cell proliferation was evident. Sparse plasma cells and lymphocytes were seen. Vascularity was increased with numerous large and small capillaries filled with RBCs [Figure 1]d and [Figure 2]d.

 Discussion



Hemangiomas are a common soft tissue tumor of the head and neck region that are often congenital or develop in the neonatal period. [4],[5] In the case presented here, the first occurrence was reported at 19 years of age. Its occurrence in the gingival mucosa is rare. The differential diagnosis of hemangiomas includes pyogenic granuloma, chronic inflammatory gingival hyperplasia (epulis), epulis granulomatosa, and squamous cell carcinoma. [6] Histopathologically, the capillary hemangioma exhibits a progression from a densely cellular proliferation of endothelial cells in the early stages to a lobular mass of well-formed capillaries in the mature phase, often resembling the pyogenic granuloma without the inflammatory features.

The present cases have clinical but not the histopathological features of a pyogenic granuloma. Therefore, biopsy of tissue specimens is often necessary for definitive diagnosis.

The range of treatment includes surgery, [6] laser therapy, [7] use of sclerosing agents, [8] and embolization. Surgical excision is generally the treatment of choice. In the reported cases, surgical excision was done based on the provisional diagnosis of pyogenic granuloma. Attempts to remove hemangiomas using surgical excision may lead to serious medical problems such as heavy bleeding. However, in this case no bleeding was encountered during excision. This might be due to the fact that the hemangioma might not be in an active proliferative phase and might not have penetrated the epithelium basement membrane interface. In addition, postoperative recurrence may occur. [6] The cases described here demonstrate that there has been no subsequent hemorrhage or other evidence of recurrence after follow up of 1 year. Still longer follow-up periods are required to provide conclusive statement.

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