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Spontaneous multifocal pyogenic granulomas.

Lindsey J Gaghan1, Isaac T Sluder2, Ashwath Sampath3

  • 1Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.

Pediatric Dermatology
|July 5, 2024
PubMed
Summary

Spontaneous multifocal pyogenic granulomas (PGs) in infants, linked to Ras/Raf/MAPK pathway variants, often resist standard treatments. Pulsed dye laser therapy shows promise for these unique vascular tumors.

Keywords:
FGFR1NRASRASRas/Raf/MAPKlobular capillary hemangiomapulsed dye laserpyogenic granulomasomatic overgrowth mutation

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Area of Science:

  • Dermatology
  • Genetics
  • Vascular Biology

Background:

  • Cutaneous pyogenic granulomas (PGs) are common benign vascular tumors with unclear causes.
  • Emerging research links PG development to genetic changes in the Ras/Raf/MAPK and PI3K/Akt/mTOR signaling pathways.

Observation:

  • This study details three infant cases of spontaneous multifocal PGs.
  • These PGs lacked other vascular anomalies or clear triggers and presented early in life.

Findings:

  • Somatic genetic variants in the Ras/Raf/MAPK pathway (NRAS, FGFR1) were identified in these PGs.
  • The PGs were unresponsive to beta-blockers and mTOR inhibitors but responded well to pulsed dye laser treatment.

Implications:

  • The findings support a genetic basis for certain PGs, particularly those involving the Ras/Raf/MAPK pathway.
  • A new term, "spontaneous multifocal PGs," is proposed for this specific clinical and genetic entity.
  • Pulsed dye laser emerges as a potential effective treatment for these refractory cases.