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Lobular Capillary Hemangioma Masquerading as Pyogenic Granuloma of Anterior Mandible: A Case Report.Cureus Jul 2023Pyogenic granuloma (PG) is a reactive connective tissue disorder with female predilection, which exhibits a tumor-like mass with occasional bleeding and superficial...
Pyogenic granuloma (PG) is a reactive connective tissue disorder with female predilection, which exhibits a tumor-like mass with occasional bleeding and superficial ulceration. It most commonly occurs in the maxillary gingiva followed by the mandibular gingiva. It can also occur in extra gingival sites like buccal mucosa, labial mucosa, and palate. There are two histopathological types of PG, namely, a lobular capillary hemangioma (LCH) variant and a non-LCH variant. The various management methods include surgical resection or laser excision along with deep curettage, and there are various nonsurgical methods like local steroid injection, topical administration of various drugs, and sclerotherapy. During the surgical excision, there is a risk of bleeding, and the surgeon should be equipped for the same. The PG (both LCH and non-LCH variant) has an increased chance of recurrence because of which complete excision is mandatory along with the removal of the local irritants. In this case report, a 28-year-old female patient reported recurrent painless swelling in the lower front gums for the past nine months. The surgical excision was done in-toto along with the removal of local irritants (calculus). The swelling was sent for histopathological examination. The patient was kept on regular follow-ups. The patient was followed up continuously for nine months. The swelling did not recur after the excision. Hence, it was concluded that complete excision and removal of local irritants are extremely crucial to prevent a recurrence.
PubMed: 37602023
DOI: 10.7759/cureus.42157 -
American Journal of Ophthalmology Case... Dec 2023To enhance the characterization of primary bulbar conjunctival basal cell carcinoma (BCC) clinically and histologically, via report of a case and review of the relevant...
PURPOSE
To enhance the characterization of primary bulbar conjunctival basal cell carcinoma (BCC) clinically and histologically, via report of a case and review of the relevant medical literature.
OBSERVATIONS
We report the case of a 73-year-old man with no history of skin cancer who presented with a bulbar conjunctival nodule without connection to the eyelid or caruncle, originally thought to represent a pyogenic granuloma. After one month without improvement on topical prednisolone, excisional biopsy was performed, with routine histopathology and immunohistochemistry. The tumor was found histologically to be primary conjunctival BCC. Immunostaining exhibited negative Ber-EP4 and S100, mostly negative CK7 and EMA, and positive p63. Margins were negative, and the patient had no recurrence six months after excision.
CONCLUSIONS AND IMPORTANCE
Primary conjunctival BCC must be considered in the differential diagnosis of a conjunctival lesion which may initially appear benign but does not behave as expected clinically. The location of the tumor in the case presented here refutes a prior postulate that primary conjunctival BCC arises from basal adnexal epithelium in the caruncle. Of the immunohistochemical findings, only the Ber-EP4 result differed from the typical immunostaining profile of cutaneous BCC. Further study is needed to determine the frequency of Ber-EP4 positivity in primary conjunctival BCC.
PubMed: 37560558
DOI: 10.1016/j.ajoc.2023.101906 -
Cureus Jul 2023Ocular pyogenic granuloma is a benign vascular tumor that occurs primarily in children. Treatment options for pyogenic conjunctival granulomas include topical steroids,...
Ocular pyogenic granuloma is a benign vascular tumor that occurs primarily in children. Treatment options for pyogenic conjunctival granulomas include topical steroids, topical timolol, surgery, cryotherapy, and electrocautery. Patients with giant pyogenic granulomas are usually treated with surgical intervention. In this case, a 13-year-old Egyptian girl developed a giant pyogenic granuloma after strabismus surgery. Topical steroids showed a poor response and failed to demonstrate any improvement. While on timolol, the granuloma completely regressed, with no signs of recurrence. Despite the usual surgical approach to the treatment of purulent giant granulomas, we believe that topical timolol can be the preferred option as a noninvasive alternative therapy since it is considered safe when compared to the potential risks of topical steroid therapy or surgical exposure.
PubMed: 37539417
DOI: 10.7759/cureus.41321 -
Acta Medica Indonesiana Apr 2023Diagnosis of nodular red lesions is challenging. The differential diagnosis includes dermal nevus, angioma, pyogenic granuloma, amelanotic melanoma, eccrine poroma,...
Diagnosis of nodular red lesions is challenging. The differential diagnosis includes dermal nevus, angioma, pyogenic granuloma, amelanotic melanoma, eccrine poroma, Kaposi's sarcoma, skin malignancy or metastasis. Erythema nodosum is one of the common consideration of the red skin nodules, however fully work up should be done to find the right diagnosis.A 60 years old female admitted to our hospital due to pain dark reddish skin nodules since one month. She had continuously high grade fever of 39 Celsius accompanied by arthralgia and fatigue since two months prior to admission and she lost 6 kg of weight in 2 months. On admission, physical examination revealed slight fever, pale conjunctiva, mild hepatosplenomegaly, tender dark red nodules 0.3 to 2 cm, firm edge, at her cheek, abdominal area and both lower extremities. No lymph nodes enlargement was noticed. Her laboratory test showed haemoglobin 9,1 g/dl, WBC 3,040/mL, PLT 149,000/mL, SGOT 48 U/L, SGPT 43 U/L, urea 12.5 mg/dL, creatinine 0.67 mg/dL. She was found to be non-reactive for HBsAg, HCV, and HIV antigens. Urine routine and microscopic examination was unremarkable.Her histopathology of left foot nodule biopsy revealed cutaneous lymphoma. The immunohistochemical (IHC) stain of CD45, CD20, and CD10 were positive, Ki67 were also positive with >70% tumor cells, while CD3,CD56, CD30, and Granzyme were negative. Her final diagnosed was Cutaneous Diffuse large B cell lymphoma.Primary cutaneous lymphomas of B-cells occur less frequently than primary cutaneous T-cells lymphomas. Primary extra-nodal diffuse large B-Cell lymphoma (DLBCL) can be seen in up to 40% of cases. However skin involvement is less common and in a large cohort of DLBCL cases, skin involvement at presentation was seen only in 3.3% of cases.It characterized by few lesions, in general showing nodules or infiltrations of relatively fast growth and have no itching. The diagnosis is made by the immunohistochemical findings, clinicopathological correlation, and molecular pathology. The lymphomas have different clinical behaviours despite being identical in morphological appearance. The primary lymphomas presents with local recurrence in up to 68% of the cases and with rare extra-cutaneous dissemination, with an average rate of 5-year survival varying from 89 to 96%. Cutaneous lymphoma should be always become one of considered diagnosed of skin red nodules even it is rare.
Topics: Humans; Female; Middle Aged; Skin Neoplasms; Skin; Melanoma; Diagnosis, Differential
PubMed: 37524604
DOI: No ID Found -
Saudi Journal of Ophthalmology :... 2023To compare the outcomes of fibrin glue versus sutures in pterygium surgery with amniotic membrane transplantation.
PURPOSE
To compare the outcomes of fibrin glue versus sutures in pterygium surgery with amniotic membrane transplantation.
METHODS
A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines. An electronic search identified all studies comparing the outcomes of using fibrin glue versus sutures in pterygium surgery with amniotic membrane transplantation. Conjunctival inflammation, postoperative pain and discomfort, pterygium recurrence, pyogenic granuloma, and surgical time were primary outcome measures. Secondary outcome measures included amniotic membrane transplant outcomes, time to recurrence, graft loss, and subconjunctival hemorrhage. Fixed and random-effects models were used for the analysis.
RESULTS
Four studies enrolling 180 patients were identified. Conjunctival inflammation (odds ratio [OR] 0.21, = 0.0005) demonstrated a significant difference favoring the fibrin glue group. Despite the trend favoring the use of fibrin glue, there were no significant differences in terms of postoperative pain and discomfort (OR = 0.46, = 0.25), pterygium recurrence (OR = 0.74, = 0.48), pyogenic granuloma (OR = 0.47, = 0.38), and surgical time (mean difference = -17.52, = 0.13). For secondary outcomes, fibrin glue had significantly fewer cases of graft loss compared with sutures. No statistically significant difference was found in amniotic membrane graft outcomes, time to recurrence, and subconjunctival hemorrhage.
CONCLUSION
Fibrin glue is comparable to the sutures used in pterygium surgery with amniotic membrane transplantation as it significantly improves conjunctival inflammation and does not increase postoperative pain and discomfort, pterygium recurrence, pyogenic granuloma, and surgical time.
PubMed: 37492203
DOI: 10.4103/sjopt.sjopt_143_22 -
Canadian Family Physician Medecin de... Jul 2023
Topics: Humans; Granuloma, Pyogenic; Treatment Outcome
PubMed: 37451992
DOI: 10.46747/cfp.6907479 -
JAAD International Sep 2023
PubMed: 37409317
DOI: 10.1016/j.jdin.2023.05.003 -
PeerJ 2023Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological... (Review)
Review
BACKGROUND
Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological changes, and increased sensitivity to pain. Pregnant women are particularly vulnerable to oral diseases, such as caries, gingivitis, pyogenic granuloma and third molar pericoronitis. Maternally administered drugs can affect the fetus through the placenta. Therefore, many physicians and patients are reluctant to provide or accept necessary local anesthesia, which leads to delays in the condition and adverse consequences. This review is intended to comprehensively discuss the instructions for local anesthesia in the oral treatment of pregnant patients.
METHODOLOGY
An in-depth search on Medline, Embase, and the Cochrane Library was performed to review articles concerned with maternal and fetal physiology, local anesthetic pharmacology, and their applications for oral treatment.
RESULTS
Standard oral local anesthesia is safe throughout the pregnancy. At present, 2% lidocaine with 1:200,000 epinephrine is considered to be the anesthetic agent that best balances safety and efficacy for pregnant women. Maternal and fetal considerations must be taken into account to accommodate the physiological and pharmacological changes in the gestation period. Semi-supine position, blood pressure monitoring, and reassurance are suggested for high-risk mothers to reduce the risk of transient changes in blood pressure, hypoxemia, and hypoglycemia. For patients with underlying diseases, such as eclampsia, hypertension, hypotension, and gestational diabetes, the physicians should use epinephrine cautiously and control the dose of anesthetic. New local anesthesia formulations and equipment, which contribute to minimizing injection pain and relieving the anxiety, have and are being developed but remain understudied.
CONCLUSIONS
Understanding the physiological and pharmacological changes during pregnancy is essential to ensure the safety and efficiency of local anesthesia. Optimal outcomes for the mother and fetus hinge on a robust understanding of the physiologic alterations and the appropriate selection of anesthetic drugs and approaches.
Topics: Humans; Female; Pregnancy; Anesthesia, Local; Anesthetics, Local; Lidocaine; Epinephrine; Pain
PubMed: 37404472
DOI: 10.7717/peerj.15585 -
The Eurasian Journal of Medicine Jun 2023The study aimed to analyze the distribution and frequency of individuals diagnosed with histopathologically non-plaque-induced gingival lesions and categorize them...
OBJECTIVE
The study aimed to analyze the distribution and frequency of individuals diagnosed with histopathologically non-plaque-induced gingival lesions and categorize them according to the non-plaque-induced gingival disease classification published at the 2017 World Workshop of Periodontology.
MATERIALS AND METHODS
Clinical features of the gingival lesion with histopathological diagnosis data in the period 1998-2003 were retrospectively analyzed . The lesions were classified as reactive lesions, malignant neoplasms, premalignant neoplasms, autoimmune disorders, benign neoplasms, hypersensitive reactions, and genetic lesions. Their distribution according to age, gender, histopathological diagnosis, and oral sites was examined. Variables were analyzed using descriptive statistics.
RESULTS
Among a total of 217 biopsied gingival samples, the most frequent pathologic nature of biopsied non-plaque gingival lesions were reactive lesions (n=80, 36.87%) and premalignant neoplasms (n=64, 29.49%). In addition, the 5 most frequent types of all cases included pyogenic granuloma (n=45, 20.74%), epithelial dysplasia (n = 40, 18.43%), papilloma (n = 33, 15.21%), epithelial hyperplasia (n = 24, 11.06%), and calcifying fibroblastic granuloma (n = 13, 5.99%).
CONCLUSIONS
In a Turkish population, the most frequently biopsied non-plaque-induced gingival lesions were reactive lesions and premalignant neoplasms. This study shows that the types of lesions that clinicians, in gen- eral, especially periodontologists, can expect to encounter in their practice are the most frequently applied gingival lesions.
PubMed: 37403906
DOI: 10.5152/eurasianjmed.2023.0088