Track

Clinical Studies

Abstract

Pyogenic granulomas are benign neoplasms of blood vessels, typically considered to be reactive to trauma, irritation, or hormonal imbalances. Superficial cutaneous and mucosal pyogenic granulomas are the most common subtypes, but deep-seated pyogenic granulomas (DSPG) have also been described. DSPG are considered a rare variant and can be seen in any age group and are commonly mistaken for other entities. We described a case series of 5 pediatric patients and their histologic characterization. Patients ranged from 5 to 16-years of age, 80% were males, and all identified as White. Two of the five patients were suspected to have a DSPG; additional diagnoses considered prior to excision included venous and lymphatic malformations, lymphangioma, hemangiomas, Spitz nevi, and pilomatricomas. Histologically, all five lesions displayed deep dermal proliferations of capillaries composed of thin-walled endothelial cells and arranged in a vaguely to clear lobular pattern.  Fibrous or sclerotic stroma was noted in 60% of specimens. Endothelial cells lining vessels stained positive for CD31 and negative for podoplanin (D240) in one lesion. The lesion concerning for a hemangioma stained negative for glucose transporter-1 (GLUT-1).  Clinicopathologic correlation of DSPG is scarce in the literature, especially in pediatric patients. Often, DSPG present as nodules without ulcerations, and their clinical and histologic appearance can mimic other common subcutaneous nodules seen in pediatric patients, including hemangiomas, venous malformations, and kaposiform hemangioendotheliomas. This case series alerts clinicians and dermatopathologists to subtle clues that can aid in the diagnosis of DSPG.