A 79-year-old female patient reported to the Department of Oral Medicine and Radiology, with a complaint of a progressively enlarging painless ulcer of the palate of six months duration. The ulcer caused difficulty in speech and swallowing due to nasal regurgitation. Her medical history revealed that she was a chronic diabetic patient with poor glycemic control. She was on insulin one year back and now on oral hypoglycemics. She gave a history of carcinoma breast and extensive esophageal candidiasis one year back for which she had undergone treatment. She also complained of severe headache, tiredness, nasal discharge and numbness over the right side of her face and appeared cachectic. Examination of the patient's face revealed no gross asymmetry. Intraorally, the ulcer measured approximately about 6x6cm involving most of the anterior part of hard palate with irregular and undermined edges [Table/ Fig-1]. There was exposed necrotic grey colored bone on the base of the ulcer and discrete areas of black eschar. Slough was seen more towards the periphery of the lesion. Oro-nasal communication of size approximately 1.5x1.5cm was present on the anterior part of the lesion towards right side and a smaller one towards left side. On palpation the lesion was tender. Upper deep cervical lymph nodes were palpable bilaterally. Multiple missing teeth, root stumps and caries exposed teeth were present in the maxillary and mandibular arches. Results of complete blood count and serum electrolyte analysis were within normal limits.

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with a chief complaint of spontaneous bleeding from gums since 1 month. The patient had consulted a physician who discerned a swelling in 43-45 tooth region. There was no associated pain. Patient was asthmatic and had a psychogenic disorder. He was under medication for these conditions. The patient was using corticosteroids, salbutamol by inhalation, for last nine years. The patient had smoking habit for 39 years but was non-alcoholic. The patient appeared chronically ill and drowsy but could be awakened easily. The pulse rate was 95/min; fast and irregular but veins appeared thickened on palpation. Respiratory rate, temperature and blood pressure were within normal limits. Right sub-mandibular and upper cervical lymph nodes were palpable but mobile and nontender. The patient passed black, sticky and tarry stools however micturition habits were normal.On intraoral inspection, a growth of about 1.5 X 2.5 cm was noticed in relation to 43-47 region [Table /Fig-1a]. The surface of the swelling was smooth and erythematous. On palpation, the growth was nontender and soft in consistency. It measured 1.7 X 2.3 X 1.4 cm, extended from distal aspect of 43 to mesial aspect of 47 and bled even on slight provocation. The margins were well defined. Oral hygiene was poor. Panoramic radiograph showed generalized bone loss [Table/ Fig-1b&c]. A clinical diagnosis of pyogenic granuloma was made and a piece of tissue was incised which was fixed in 10% formalin and sent to the Department of Oral Pathology and Microbiology for histopathological examination.