Case study: Pyogenic granuloma localized on the lingual palatal mucosa of No. 14-15 in a 72-year-old man

This case report describes the unusual presentation of a pyogenic granuloma in a 72-year-old man. Although pyogenic granulomas are common benign vascular lesions, they typically occur in younger individuals and pregnant women. Their presence in older men underscores the importance of a comprehensive differential diagnosis of oral lesions.

Pyogenic Granuloma: An Overview

Although the name suggests an infectious process, pyogenic granuloma is a benign vascular tumor characterized by excessive growth of capillaries and fibroblasts. While the exact etiology remains unclear, the pathogenesis is often due to a combination of factors, including local irritation, trauma, hormonal fluctuations, and certain medications. The interaction of these factors triggers a cascade of events that leads to the characteristic clinical appearance of this lesion.¹

Local irritation or trauma, such as chronic inflammation due to poor oral hygiene or accidental injury, can trigger an inflammatory response that stimulates the release of growth factors and cytokines, thereby promoting angiogenesis (formation of new blood vessels) and the proliferation of fibroblasts.²

Hormonal changes, particularly during pregnancy or puberty, may also influence the development of pyogenic granulomas due to their effects on vascular reactivity and tissue growth. In some cases, certain medications such as oral contraceptives and retinoids have been associated, although the exact mechanism is unclear.

Rapid proliferation of capillaries and fibroblasts results in a highly vascularized, friable lesion that bleeds easily. This explains the clinical appearance of a solitary, red-violet nodule, often pedunculated or sessile, and prone to bleeding even with mild manipulation.

The size of these lesions can vary considerably, ranging from a few millimeters to several centimeters. They typically appear on the gums, lips, tongue and oral mucosa.³ However, they can also occur in extraoral locations, such as the skin and nasal septum.

Understanding the pathogenesis of pyogenic granuloma is crucial for accurate diagnosis and appropriate treatment.⁴ By identifying the possible triggers and resulting cellular changes, clinicians can differentiate this lesion from other diseases with similar clinical presentation, such as peripheral giant cell granuloma, peripheral ossifying fibroma, hemangioma, and oral squamous cell carcinoma.⁴