Idiopathic huge pyogenic granuloma in young and old: An unusually large lesion in two cases

Pyogenic granuloma (PG) is a reactive hyperplasia of connective tissue in response to local irritants, chronic irritation and hormonal changes. It is a tumor-like growth of the oral cavity frequently located in the region surrounding the anterior teeth or skin. It usually arises in response to various stimuli, such as low-grade local irritation, traumatic injury, hormonal factors or certain kinds of drugs. Clinically, the lesion appears as a smooth, lobulated, exophytic mass, exhibiting pink to reddish-purple color which can bleed on slight manipulation. PG has no malignant potential, but recurrence is common after surgical excision. Histologically, the surface epithelium may be intact and may show foci of ulcerations or exhibit hyperkeratosis. Gingiva is the most common site affected followed by buccal mucosa, tongue and lips. The size of lesion varies from millimeters to several centimeters; rarely exceeding 2-2.5 cm. PG larger than 2.5 cm are seldom reported. Estrogen has been considered as a major contributing factor in most of the cases. Thus, occurrence of PG is mostly seen in premenopausal age due to high levels of estrogen. In this article, two unusually large oral PG have been reported. In the first case, a 25-year-old young male patient and in the second case, 70-year-old female patient have been described. In both the cases, the size of lesion was more than 5 cm which has been rarely reported before. Also one of the cases describe here is of a postmenopausal female, which questions role of estrogen as an etiological factor.