Pyogenic granuloma of the sigmoid colon

González‐Vela, M. Carmen; Val-Bernal, J. Fernando; Garijo, M. Francisca; García-Suárez, Covadonga

doi:10.1016/j.anndiagpath.2004.12.009

Cited by 22 publications

(8 citation statements)

References 9 publications

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“…Another case report (8) suggested the development of a PG in the terminal ileum after recovery from Campylobacter enteritis. Clinically, patients with PG can be asymptomatic or present with overt bleeding from the lesion (7,9). PG has also caused common bile duct obstruction in a single case (10), and dysphagia in two others (5,11).…”

Section: Cell Population (Immunoperoxidase Stain Original Magnificatmentioning

confidence: 99%

Pyogenic Granuloma: An Unusual Cause of Massive Gastrointestinal Bleeding from the Small Bowel

Moffatt

Warwryko

Singh

2009

Canadian Journal of Gastroenterology

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G astrointestinal (GI) bleeding in the small intestine -distal to the duodenum -is an uncommon entity and is responsible for 4% of all cases of GI bleeding (1). The most common etiologies for small intestinal bleeding are angiodysplasias and tumours, responsible for approximately 70% and 10% of cases, respectively (1,2). Pyogenic granuloma (PG) is a common inflammatory vascular tumour of the skin and oral cavity that has rarely been described in the GI tract as a source of obscure and overt bleeding. In the present report, we describe the first case of massive GI bleeding caused by a small bowel PG, and we review the relevant literature to date regarding the clinical presentation, diagnosis and management of this rare GI lesion. Case presentationThe case of a 78-year-old Caucasian man with longstanding anemia (hemoglobin 80 g/L to 100 g/L) followed by a hematologist for suspected myelodysplasia is reported. On worsening of his anemia, and with decreasing serum ferritin and iron saturation levels, he was diagnosed with iron deficiency anemia and a GI source of blood loss was suspected. Diagnostic esophagogastroduodenoscopy, colonoscopy and small bowel follow-through did not reveal the source of bleeding. A technetium 99m-tagged red blood cell scan was performed and suggested bleeding in the right upper quadrant; however, the source was not clearly identified as being in the large or small bowel.Shortly thereafter, the patient presented to hospital with presyncope, hemodynamic instability and large volume melena. He was hospitalized and required transfusion of eight units of packed red blood cells over a 24 h period. His nadir hemoglobin was 62 g/L, at which point he was transferred to the Health Sciences Centre at the University of Manitoba, Winnipeg, Manitoba, for further assessment and management. An urgent small bowel push enteroscopy identified a 2 cm polypoid lesion approximately 20 cm into the jejunum. The lesion was reddish-blue in colour, with a white coating and superficial ulceration (Figure 1 Small bowel hemorrhage is responsible for approximately 4% of all cases of gastrointestinal bleeding. The etiology of bleeding from the small bowel is a tumour in approximately 10% of cases. Pyogenic granuloma is a common inflammatory vascular tumour of the dermis, which rarely occurs in the gastrointestinal tract. Pyogenic granuloma is a rare cause of overt or obscure small bowel bleeding. The present paper reports the first case of pyogenic granuloma presenting as a massive gastrointestinal bleed, and reviews the relevant literature to date regarding the clinical presentation, diagnosis and management of this rare gastrointestinal lesion.

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Section: Cell Population (Immunoperoxidase Stain Original Magnificatmentioning

confidence: 99%

Pyogenic Granuloma: An Unusual Cause of Massive Gastrointestinal Bleeding from the Small Bowel

Moffatt

Warwryko

Singh

2009

Canadian Journal of Gastroenterology

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“…[8] The most common location in our series is the sigmoid colon, and these lesions were mostly picked up on screening colonoscopy. However, there have been reports of PG of sigmoid colon causing rectal bleeding and requiring endoscopic resection [9] or causing constipation, treated with argon plasma coagulation treatment. There was an exceptional case of multiple PG detected by single photon emission computed tomography using 99 Tcm in a 73-year-old man with 2 year history of intermittent lower GI bleed who was found to have disseminated PG involving skull, abdominal wall, intestine, scrotum, and right leg.…”

Section: Discussionmentioning

confidence: 99%

Pyogenic granuloma of the gastrointestinal tract

Mittal

Nabi

et al. 2014

Journal of Digestive Endoscopy

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Introduction: Pyogenic granuloma (PG) or granuloma pyogenicum is essentially a capillary hemangioma on the skin or a mucosal surface which shows an exophytic growth pattern and has a lobulated appearance. The most common sites are skin (40%) and mucosal surfaces (predominantly oral cavity, 60%). We intend to report all available cases of PG of gastrointestinal (GI) tract, diagnosed at the Henry Ford hospital, a tertiary referral center. Patients and Methods: A retrospective review of pathological database was performed on all GI biopsies in the last 10 years using diagnostic codes and pathology codes searching for PG of the GI tract. Results: A total of 23 cases of pathologically diagnosed PG was diagnosed over a 10 year period. The median age of patients was 64 with almost equal gender distribution (47.8% were males, and 52.2% were females). The most common location of PG was sigmoid colon (65.2%), esophagus (17.4%) and transverse colon (13%). PG presented as a polyp in 16 patients (69.6%). The most common indication for endoscopy in these cases was screening colonoscopy (30.4% cases). Discussion: PG of GI tract is rare. To date, only about 15–20 cases have been reported in the literature and most cases have been reported from Japan and Korea. This is the largest case series of this rare pathological lesion of the GI tract. Most cases of PG were diagnosed on an endoscopy done for an unrelated reason in our series. Hence, most cases were asymptomatic, unlike previously reported cases which were mostly associated with GI bleeding.

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“…Pyogenic granuloma was diagnosed based on the histological identification of a lobular arrangement of multiple capillaries lined by endothelial cells, and edematous stroma with inflammatory cell infiltration and fibroblast proliferation in routine hematoxylin and eosin (HE)‐stained sections of formalin‐fixed, paraffin‐embedded materials (Fig. 1) [4,7–9]. The specimens in all patients were acquired by biopsy forceps from areas of polypoid lesions or ulcers.…”

Section: Methodsmentioning

confidence: 99%

Clinical and endoscopic features of gastric pyogenic granuloma

Lin

Hsieh

Hsu

et al. 2014

Adv in Digestive Medicine

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Background: Pyogenic granuloma (PG) is a polypoid form of capillary hemangioma. This study aimed to analyze the clinical and endoscopic features of gastric PG. Methods: We retrospectively reviewed nine patients with gastric PGs who were evaluated by esophagogastroduodenoscopy and diagnosed by pathological study at the Chang Gung Medical Center (Taoyuan, Taiwan) between 2000 and 2009. Demographic data, clinical presentations, endoscopic findings, treatment, and outcome were collected and analyzed. Results: The median age of the study patients was 62 years (range, 40e73 years) with a female preponderance. The most common symptom at presentation was overt gastrointestinal bleeding, followed by anemia and epigastralgia. Two patients were asymptomatic at diagnosis. The most common underlying diseases were liver cirrhosis [5 (56%) patients] and hypertension [5 (56%) patients]. Five (56%) cases of gastric PGs originated at the site of prior ulcer lesions. Most gastric PGs were solitary [7 (78%) patients] and located in the antrum [8 (89%) patients]. The gastric PGs typically appeared morphologically as smooth protruding hyperemic lesions with adherent white or yellow deposits. One patient received an endoscopic mucosal resection with complete excision of the lesion. Another patient received surgical intervention. Four gastric PG lesions were stationary or regressed with conservative management. Conclusion: Overt gastrointestinal bleeding was the most common clinical presentation in patients with gastric PG. Gastric ulcers were the most common precursors of PG with the antrum being the most frequent site involved. Gastric PGs were characteristically protruding hyperemic lesions with adherent exudates. Conservative treatment may be considered for

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Pyogenic granuloma of the sigmoid colon

Cited by 22 publications

References 9 publications

Pyogenic Granuloma: An Unusual Cause of Massive Gastrointestinal Bleeding from the Small Bowel

Pyogenic Granuloma: An Unusual Cause of Massive Gastrointestinal Bleeding from the Small Bowel

Pyogenic granuloma of the gastrointestinal tract

Clinical and endoscopic features of gastric pyogenic granuloma

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