The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Stephanie V. Sherman, M.D., Editor

Pyogenic Granuloma
A B

A
45-year-old woman with type 2 diabetes presented to the plas- David Komakech, M.B., Ch.B.
tic surgery clinic with a 6-week history of a painless upper-lip lesion. The Saint Mary’s Hospital Lacor
lesion had rapidly increased in size over the previous 3 weeks and bled Gulu, Uganda
when lightly touched. The patient was not pregnant. On physical examination, the komakechdavid21@gmail.com
lesion was found to be an erythematous, round, smooth, pedunculated mass Brian Ssenkumba, M.B., Ch.B.
(Panel A). It was friable but not tender to touch. Histopathological examination of
Mbarara University of Science
an excisional biopsy specimen showed proliferating vessels, fibroblasts, numerous and Technology
inflammatory cells, and surface ulceration, findings consistent with pyogenic Mbarara City, Uganda
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.
DOI: 10.1056/NEJMicm2204602
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