Reactive lesions of the gingiva. A clinicopathological study of 741 cases

A series of 741 consecutive cases of localized hyperplastic lesions of the gingiva were studied. The lesions were reclassified into four groups: pyogenic granuloma, peripheral giant cell granuloma, fibrous hyperplasia and peripheral fibroma with calcification. This study indicates that there are some differences between these groups in age and sex distribution as well as in location and size of the lesion. Fibrous hyperplasia was the most common type, followed in descending order by pyogenic granuloma, peripheral fibroma with calcification and peripheral giant cell granuloma. The peripheral giant cell granuloma showed no sex predilection while fibrous hyperplasia, pyogenic granuloma and peripheral fibroma with calcification were more common in females. Pyogenic granuloma and peripheral fibroma with calcification occur in younger patients more often than fibrous hyperplasia, and thus may represent a stage in the development of fibrous hyperplasia.     

Calprotectin levels in oral fluids: the importance of collection site

A clinical analysis of 304 cases of pyogenic granuloma (excluding pregnancy tumour) were obtained from the clinical evaluations submitted by clinicians while sending specimens for biopsy. The average age of the patients with pyogenic granuloma was 28.9 years with a peak age incidence in the second decade. More female patients were affected and the lesions present mainly in the Chinese. The majority of the lesions were ulcerated and pedunculated. The lesions had a mean diameter of 10.8 mm with a mean lesion duration of 6.0 months. The gingiva was the prevalent site for these lesions with a greater number being located in the maxilla. The recurrence rate was found to be 14.1%.     

Pyogenic granuloma-like lesions in a patient using topical tretinoin

A 16-year-old male developed numerous pyogenic granuloma like-lesions across his neck, chest and back after 6 weeks isotretinoin therapy for cystic acne. The isotretinoin was ceased and he was commenced on oral steroids. After 6 weeks, the lesions were almost completely healed. However, due to worsening comedonal acne, the patient was commenced on topical tretinoin cream 0.05% twice daily to his chest. He was reviewed 2 weeks later and, surprisingly, 2 new pyogenic granuloma-like lesions had developed on his chest. These lesions persisted until the topical tretinoin was ceased 3 months later.     

Phacomatosis pigmentovascularis type IIb associated with Sturge-Weber syndrome and pyogenic granuloma

A case of phacomatosis pigmentovascularis (PPV) in a 6-year-old girl with Sturge-Weber syndrome, pyogenic granuloma, and other complications is described. It is relatively rare that a complete form of Sturge-Weber syndrome was associated with PPV. A review of the literature on PPV, focusing on total number of reported cases and etiological speculations, is presented. To our knowledge, a total of 118 cases of PPV, including the present one, have been reported to date. Regardless of many speculations, the true etiology remains unknown. The average "density" of mast cells (MCs) per mm2 appearing in the central region of the pyogenic granuloma was calculated to be 86.3/mm2 and that in the adjacent nevus flammeus was 37.9/mm2. The "density" of mast cells in pyogenic granuloma separately calculated from ten other cases was 105.5 +/- 28.6/mm2 (mean +/- SD), compared with that in normal skin, 6.85 +/- 4.9/mm2 (n = 20). There was a significant difference between the two, indicating that MCs are closely associated with angiogenesis in pyogenic granuloma.     

Malignant neoplasms metastatic to gingivae

Malignant neoplasms metastatic to the gingivae are rare. Our review of the literature revealed only eight acceptable examples. We are reporting two additional cases. One patient was a 58-year-old man with an adenocarcinoma of the lung which metastasized bilaterally to the maxillary gingiva. The second patient was a 27-year-old man with a synovial sarcoma which metastasized to multiple sites in the maxillary and mandibular gingiva. Clinically, gingival metastatic lesions are most often confused with hemangioma, pyogenic granuloma, giant-cell granuloma, and pepripheral fibroma. They usually occur late in the course of the disease and are associated with metastatic deposits in many other organs and tissues. Death usually occurs in a few weeks or months after discovery of the gingival metastasis.     

Clinical diagnosis and management of hormonally responsive oral pregnancy tumor (pyogenic granuloma)

OBJECTIVE: To present a review of our experience and that of the medical literature in the diagnosis and management of oral pregnancy tumor (pyogenic granuloma), the natural History of the disease, its hormonal etiology, histopathologic features and management strategies. STUDY DESIGN: Medical literature review. RESULTS: This common, benign, hyperplastic oral mucosal lesion is much less familiar to gynecologists and obstetricians than to dentists. CONCLUSION: For practitioners engaged in primary care obstetrics and gynecology, routine oral examination and proper identification of pyogenic granuloma are important to avoid misdiagnosis and overtreatment.     

Common problems in wound care: caring for the skin around wounds

A case of pyogenic granuloma of the prepuce is presented. This to our knowledge, is the first reported case of this condition affecting this site.     

Eruptive epithelioid hemangioendothelioma with spindle cells

A 39-year-old white man presented with four discrete dermal nodules in his right upper arm. Biopsy revealed superficial dermal well-circumscribed nodules composed of solid areas and vascular spaces lined by epithelioid endothelial cells and a similar nodule composed of spindle and epithelioid cells. A moderate mitotic count of 3-4 mitoses/10 hpf was present. Multiple lesions erupted 1 month later distally and proximally to the original lesions. Magnetic resonance imaging of the right arm demonstrated a lesion in the humerus. Biopsy of the humerus showed a vascular tumor with similar histologic features to the overlying skin lesions. The differential diagnosis included epithelioid vascular tumors, bacillary angiomatosis, pyogenic granuloma, and Kaposi sarcoma. Vascular lesions containing epithelioid and spindle cells span a spectrum from benign to malignant. We believe these tumors belong in the category of hemangioendothelioma and propose the name eruptive epithelioid hemangioendothelioma with spindle cells. Our case emphasizes that eruptive cutaneous vascular lesions do not always suggest immunosuppression or malignancy. Additionally, it highlights the association between epithelioid vascular lesions of the skin and bone.     

Verrucous carcinoma of skin: epithelioma cuniculatum plantare

Eight patients had plantar growths that were usually irregularly shaped, sharply outlined, verrucous, and several centimeters in greatest dimension. Clinical diagnoses included viral wart, deep mycosis, pyogenic granuloma, amelanotic melanoma, basal cell carcinoma, and eccrine poroma. The median age of the patients, and duration of the growth, were 52 and 16 years, respectively. Therapeutic modalities other than total excision were ineffective. The tumor, derived from surface epidermis, was composed of masses of pale-staining benign-appearing prickle cells, deeply invaginated by thick, compact, partially parakeratotic horn. Several lesions have recurred; amputation was required in one patient. This distinctive entity, apparently not described in the American literature, has been reported from Europe under such titles as epithelioma cuniculatum and papillomatosis cutis carcinoides. We believe that it is best interpreted as a form of verrucous carcinoma, the first cutaneous tumor--as opposed to lesions of mucous membranes and mucocutaneous junctions--to be so classified.     

Influence of nicotine on progesterone and estradiol production of cultured human granulosa cells

A case of peripheral ameloblastoma in a 57-years-old woman is presented, along with a discussion of the clinical and histological characteristics of the lesion. After clinical and radiographic examinations, and with a differential diagnosis of pyogenic granuloma, an excisional biopsy was performed and the material collected was sent for histological examination. On the basis of the histopathological diagnosis, a second operation was performed with a wide safety margin, including bone tissue, which did not show any involvement with the odontogenic neoplasm.     

Dermal and intravascular fasciitis. Unusual variants of nodular fasciitis

Three cases with characteristic features of nodular (pseudosarcomatous) fasciitis arising in the dermis are described. This is only the second report documenting a dermal location for this condition. One of the three cases also showed features of intravascular fasciitis. A fourth case of intravascular fasciitis arising in periocular tissue is included. The differential diagnosis of dermal fasciitis includes benign fibrous histiocytoma, pyogenic granuloma, peripheral nerve tumors, cutaneous smooth muscle tumours, spindle cell carcinoma, spindle cell melanoma, dermatofibrosarcoma protuberans and atypical fibroxanthoma.     

Inhibitors of mitochondrial energy production prevent DNA internucleosomal fragmentation in thymocytes

We describe a case of multiple hepatic pyogenic abscesses with an unusual presentation. The typical signs and symptoms of fever and pain in the right upper quadrant were absent. Instead, the chief complaint was muscle weakness and myalgias accompanied by weight loss. Findings from an ultrasonogram of the abdomen revealed multiple hepatic lesions consistent with metastases. Hence, the initial presumptive diagnosis was metastatic malignancy with unknown primary tumor. It was only when purulent material was unexpectedly encountered when a needle biopsy was performed that the true diagnosis of pyogenic liver abscess was recognized. While liver abscess is rare, it should not be forgotten in the differential diagnosis for multiple hepatic lesions seen on imaging studies.     

Granulomatous mycosis fungoides with small intestinal involvement and a fatal outcome

We report a case of granulomatous mycosis fungoides that progressed into fatal gastrointestinal involvement 4 years after the onset of skin lesions, despite improvement of the skin lesions in response to a combination of PUVA and systemic interferon-gamma therapy. Histological examination showed Pautrier's microabscesses with granuloma annulare-like features and sarcoidal granuloma formation in the plaque stage, proliferation of blast-transformed atypical lymphocytes with persistent granuloma formation in the tumour stage, and metastatic lesions. A literature review of granulomatous mycosis fungoides revealed that 11 of the 24 reported cases died of the disease, and like our case, seven died within 5 years. We suggest that mycosis fungoides with granulomatous reactions does not indicate a favourable prognosis.     

Eosinophilic granuloma of the proximal tibial epiphysis

This is a 3-year follow-up report of an eosinophilic granuloma of bone occurring in a growing epiphysis. The lesion occurred in a 6-year-old boy and is only the third such case reported in the literature. Eosinophilic granuloma should be considered in the differential diagnosis of lytic lesions of the epiphysis in childhood.     

Clinical evaluation of Dyract in primary molars: 3-year results

Connective tissue growth factor (CTGF) is a member of a family of immediate early gene products that may play an important role during tissue regeneration, wound repair and skin fibrosis. In this study, CTGF gene expression in mesenchymal tumors was investigated by in situ hybridization and CD34 antigen expression was studied by means of immunohistochemical staining. CTGF mRNA was expressed in fibroblasts of all nine dermatofibromas examined, but five of seven dermatofibrosarcoma protuberans (DFSP) or two cases of malignant fibrous histiocytoma were negative for its expression. In contrast, CD34 antigen was expressed only in DFSP. In vascular tumors, CTGF mRNA was expressed in pyogenic granuloma but not in angiosarcoma. In addition, the endothelial cells in angiolipoma and angioleiomyoma, but not in venous lake, expressed CTGF mRNA. These vascular lesions were all positive for CD34 expression. Tumors of other origins were negative for CTGF mRNA. Our findings indicated that benign fibroblasts and/or vascular endothelial cells have the capability to express CTGF mRNA when activated, but these cells lose this ability when they achieve malignant potency. Thus, examination of CTGF gene expression may be useful for differentiating between benign and malignant mesenchymal tumors, or to determine the origin of the tumors in connective tissue.     

Masson's "vegetant intravascular hemangioendothelioma:" a lesion often mistaken for angiosarcoma: study of seventeen cases located in the skin and soft tissues

The occurrence of Masson's "hemangio-endotheliome vegetant intravasculaire" (Masson's pseudoangiosarcoma) in the skin and soft tissues is illustrated with 17 surgically excised specimens. Two forms are recognized; it may appear either as a pure lesion or as a focal condition in a pre-existing vascular process, such as pyogenic granuloma or hemangioma. The clinical appearance is not specific and the diagnosis can only be established by microscopic examination. It shows a predilection for the head and extremities. Its characteristic morphologic appearance makes possible its differentiation from a group of benign and malignant vascular proliferations. The key microscopic feature is the presence of a papillary growth composed of hyperplastic endothelial cells supported by delicate fibrous stalks entirely confined within the vascular lumen. The lesion should not be mistaken for angiosarcoma, since its clinical behavior is invariably benign.     

Cardiac asystole during dobutamine stress echocardiography

As hepatitis B vaccination is becoming generalized in Europe, cutaneous adverse events are being more frequently reported in the literature. We report the first case of generalized granuloma annulare following hepatitis B immunization. A 51-year-old woman presented a generalized granuloma annulare one month after the one-year booster injection of the hepatitis B vaccine. The lesions resolved with sulfone therapy. We observed an identical recurrence three weeks after the five-year booster.     

Sweat gland carcinoma. Current concepts of surgical management

In three new cases of sweat gland carcinoma that we observed within recent years, the sites were the axilla, back, and arm. Axillary lymph node dissections were performed in two of the patients and the nodes were normal. Preoperative diagnoses were hydroadenitis, squamous cell carcinoma of the skin, and pyogenic granuloma. In one patient who was followed up for four years, there has been no recurrence; the follow-up period for the other two has been short. Sweat gland carcinoma is an uncommon neoplasm that occurs mostly in the older age groups. It may be very slow growing and is extremely difficult to diagnose preoperatively. Lymph node metastases are frequent and overall survival is poor. Prognosis is related to histologic cell type and presence or absence of lymph node metastases. Treatment by wide local excision of the lesion and primary regional node dissection is recommended.     

Anatomical and functional considerations in total claviclectomy

There should be no hesitation in performing a total claviclectomy. It is the treatment of choice in cases of ch. pyogenic osteomyelitis of the clavicle and other lesions which demand sacrificing the bone. There was no functional impairment of the shoulder joint or the girdle. There is usually no major postoperative complication and no residual disability. In children, regeneration of bone takes place from the periosteal tube.     

Medial canthoplasty for optimum support of the lower eyelid in 14 patients

BACKGROUND AND OBJECTIVES: Medial canthoplasty surgically fuses the upper and lower lids medial to the puncta. The authors modified the procedure by inserting a temporary lacrimal stent in order to avoid kinking and scar contracture of the canaliculi. PATIENTS AND METHODS: A medial canthoplasty successfully corrected lower eyelid laxity in 14 patients with the following conditions: (1) exposure and/or neurotrophic keratitis with medial ectropion and/or retraction of the lower eyelid (11 patients), and (2) inability to retain a prosthesis because of lower eyelid ectropion and contracture of the inferior conjunctival fornix (3 anophthalmic patients). RESULTS: All patients had a satisfactory cosmetic result despite minimal vertical and horizontal narrowing of the palpebral fissure. Complications included partial wound dehiscence and pyogenic granuloma. CONCLUSION: The modified medial canthoplasty described in this article corrects medial ectropion with minimal cosmetic deformity.