INTRODUCTION Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular tumor. The intravascular variant is an angiomatous proliferation that occurs within a blood vessel sometimes associated with an underlying arteriovenous malformation or hemangioma. The lesion is a polypoid mass projecting into the lumen of a dilated vein.
CLINICAL PRESENTATION Intravascular pyogenic granuloma occurs within a vein such as the angular vein.
It presents as a slowly enlarging deep firm nontender mass. There are no epithelial changes or erythema. The lesion is mobile and can be elongated and tubular to palpation.
HISTOPATHOLOGY This lesion occurs in veins and represents the intravenous analog of pyogenic granuloma of the skin or conjunctiva. There is a proliferation of blood vessels within the vessel lumen, and sometimes a stalk connecting the lesion to the vein wall can be identified. On other occasions, the lesion appears to be floating within the vessel lumen or it may completely occlude the lumen. In addition to the endothelial cells, smooth muscle cells can be demonstrated immunohisto-chemically within the tumor and are presumed to represent residua of the vein wall.
DIFFERENTIAL DIAGNOSIS The differential diagnosis includes lesions such as intravascular papillary endothelial hyperplasia, pyogenic granuloma, angiosacoma, hemangioma, Kaposi's sarcoma, and organized thrombus.
Intravascular Pyogenic Granuloma (Contd.)
TREATMENT Treatment is often required for diagnosis. Removal is accomplished by opening the vein with removal of the mass which shells out easily.
Hung CH, Kuo HW, Chiu YK, Huang PH. Intravascular pyogenic granuloma arising in an acquired arteriovenous malformation: report of a case and review of the literature. Dermatol Surg 2004; 30:1050-1053. Inaloz HS, Patel G, Knight AG. Recurrent intravascular papillary endothelial hyperplasia developing from a pyogenic granuloma. J Eur Acad Dermatol Venereol 2001; 15:156-158. Truong L, Font RL. Intravascular pyogenic granuloma of the ocular adnexa. Report of two cases and review of the literature.
Arch Ophthalmol 1985; 103:1364-1367. Ulbright TM, Santa Cruz DJ. Intravascular pyogenic granuloma: case report with ultrastructural findings. Cancer 1980; 45:1646-1652.
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