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Pyogenic granuloma appearing on port-wine stain: a case report
1Department of Plastic and Reconstructive Surgery, Medical School, Dicle University, Diyarbakir, Turkey. iaskar@superonline.com
Background:
Pyogenic granuloma has been reported to be associated with hemangiomas and hamartomas, including port-wine stain. It has been suggested that the spontaneous development of pyogenic granuloma in port-wine stain might be associated with microscopic arteriovenous anastomoses in highly vascularized areas such as the fingers, hands, lips, tongue and face.
Case Report:
A 25-year-old male patient presented with a history of a reddish, solitary nodule on the posterior cervical area for eight months. There had been an associated port-wine stain at the same localization since birth. Physical examination revealed a solitary, strawberry-like dome-shaped papule, 12 mm in diameter, within a well-demarcated reddish colored surrounding patch which had been present on the posterior cervical area. The lesion was excised, considering pyogenic granuloma arising in a port-wine stain. Histopathologic examination showed a mass of capillaries with variable luminal diameters, infiltration of inflammatory cells, and immature endothelial proliferation in the upper dermis. The capillaries were organized into lobules separated by fibrous stroma and were surrounded by an epithelial collarette. Immunohistochemical staining for factor VIII-related antigen supported all these findings of the port-wine stain.
Conclusion:
We present a pyogenic granuloma arising in port-wine stain on the posterior cervical area, since the posterior cervical area is not as highly vascular as the fingers, hands, lips, tongue and face. We believed that the collar of the patient's shirt continuously traumatized port-wine stain, and consequently led to the development of pyogenic granuloma.
Insights
Pyogenic granuloma can develop in port-wine stains, even in less vascular areas like the neck. Continuous minor trauma, such as from clothing, may trigger this association.
Area of Science:
- Dermatology
- Vascular Malformations
- Pathology
Background:
- Pyogenic granuloma is occasionally associated with vascular anomalies like port-wine stains.
- Microscopic arteriovenous anastomoses in highly vascular areas are hypothesized to contribute to this association.
Observation:
- A 25-year-old male presented with a nodule on a congenital port-wine stain in the posterior cervical area.
- Physical examination revealed a strawberry-like papule within a reddish patch.
- Histopathology confirmed pyogenic granuloma with capillary proliferation and inflammation.
Findings:
- The case demonstrates pyogenic granuloma arising in a port-wine stain on the posterior neck, an area not typically considered highly vascular.
- Histopathology revealed characteristic features of pyogenic granuloma, including lobular capillary proliferation and inflammatory infiltrate.
- Immunohistochemistry supported the diagnosis and findings related to the port-wine stain.
Implications:
- This case suggests that factors other than high vascularity, such as chronic minor trauma from clothing, can lead to pyogenic granuloma formation in port-wine stains.
- The findings expand the understanding of pyogenic granuloma development in vascular malformations.
- Highlights the importance of considering external factors in the pathogenesis of lesions associated with vascular anomalies.