Intravenous Pyogenic Granuloma

Intravenous pyogenic granuloma (IVPG) is an extremely rare polypoid variant of lobular capillary hemangioma . It was first described in 1979 by Cooper et al. and a most recent review found less than 30 cases reported in literature until now. IVPG has been seen in patients from 15 to 66 years of age (average 38 years) and with a slight female predominance. These lesions are commonly thought to arise in upper extremities and in neck and head veins. IVPG is a benign intravascular lesion with no potential for haematogenous spread. The proliferation is entirely confined within a vein lumen and a fibrovascular stalk attaches the lesion to the wall of the vein with a nearby small artery thought to provide its blood supply. The surface of the tumor exposed to the vein lumen is covered by an endothelial lining. Typical histological features include lobules of capillaries within an edematous fibromyxoid stroma . Histological appearances are similar to those of a classical pyogenic granuoma, but with absence of inflammatory changes. The treatment of choice is complete local excision and the prognosis is excellent. There are no known associated risk factors and the pathogenesis of the lesion has not been determined .Early-stage tumors in asymptomatic patients are increasingly discovered as a result of the easy availability and widespread use of ultrasonography. In our patient an abdominal ultrasound was performed to investigate lower urinary tract symptoms related to benign prostate hyperplasia. A mass was discovered and it was found to be a very rare tumor.IVPG is a benign entity that has important clinical implications; in fact it can easily mimic a malignant lesion at imaging. The clinical picture of the IVPG is highly nonspecific and insufficient to make a precise diagnosis. There are no known associated risk factors and the nature of the lesion remains obscure. However, the histological picture of IVPG is particularly characteristic and manifests a remarkable resemblance throughout series described until now. Immunostaining of the surgical specimen is considered an useful aid for diagnosis. Our tumor showed a strong expression for antigens as CD34, CD31 alpha-smooth muscle actin and desmin that helped us to put the correct diagnosis. The tumor should be differentiated from other intravascular lesions including thrombus, angiosarcoma, hemangiothelioma and intravascular papillary endothelial hyperplasia. Angiosarcoma does not show a distinctive lobular pattern but rather is usually poorly organized, diffuse and infiltrative; the cytologic pattern is characterized by nuclear hyperchromasia and pleomorphisms. The hemangiothelioma has an intermediate position between well differentiated hemangioma and anaplastic angiosarcoma. Finally intravascular papillary endothelial hyperplasia can be distinguished from intravenous pyogenic granuloma by its papillary architecture, presence of hemosiderin deposits and association with organized thrombi. OMICS Group International is one of the leading Open Access Publishing houses, which has around 700+ peer-reviewed journals, 50,000+ editorial board members, and highly qualified, expert reviewers to meet the objectives of the Peer-Review Process. OMICS Group International peer-review policies are highly appreciated, accepted and adaptable to the criteria that have been prescribed by the international agencies such as NIH, PubMed etc. OMICS Group International also organizes 3000+ International Scientific Conferences per year globally. There is a great deal of information out there on scientific topics. However, whether it can be trusted or not is a key issue at present. The main question that often emerges in this aspect is about the review process adopted to screen the articles for publication. One of the most acceptable and proven process adopted in majority reputed international journals is peer reviewing.

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Last date updated on November, 2024