International Journal of Medical and Dental Case Reports (2018), Article ID 060427, 3 Pages

CASE REPORT

“Lobular capillary hemangioma in a rare location” – A case

report
Ramya Rai, Shreya Dasgupta, Prashant Babaji, K. K. Shashibhushan
Department of Pedodontics and Preventive Dentistry, Sharavathi Dental College and Hospital, Shimoga, Karnataka, India

Correspondence: Abstract
Dr. Shreya Dasgupta, A female patient presented with an unusual location of pyogenic granuloma on the
Department of Pedodontics and Preventive
ventral surface of the tongue. These lesions are seen mostly between ages ranging
Dentistry, Sharavathi Dental College and
from 11 to 40 years and occur frequently on gingiva but less frequently on the tongue.
Hospital, Shimoga, Karnataka, India.
Phone: 91-8087056794.
Identification of the primary etiological factors and its removal followed by excisional
E-mail: [email protected] biopsy with definitive histopathological diagnosis was done. Follow-up of the patient
showed no recurrence.
Received 5 March 2019;
Accepted 10 April 2019 Keywords: Capillary, hemangioma, lobular, tongue

doi: 10.15713/ins.ijmdcr.115

How to cite the article:

Rai R, Dasgupta S, Babaji P, Shashibhushan KK.
“Lobular capillary hemangioma in a rare
location” – A case report. Int J Med Dent Case
Rep 2018;5:1-3.

Introduction On inspection, a well-defined, reddish pink solitary localized

exophytic growth was seen in the midline of the ventral surface of
Pyogenic granuloma (PG) or Lobular capillary hemangioma the tongue. The surface was smooth with no ulcerations. Miller’s
(LCH) is a common benign soft tissue tumor that is thought to Class III gingival recession with respect to 31 and 41 was seen on
arise from the connective tissue of the skin or mucous membrane. intraoral examination with moderate calculus [Figure 1].
The term PG paradoxically neither implies to a lesion that is On palpation, inspection findings were confirmed.
infectious nor granulomatous, but on the contrary, it is a reactive The swelling appeared to be sessile, leaf-  like in shape and
inflammatory process to some low-grade chronic irritation.[1] measured approximately 1.5  cm × 0.5 cm in size. It was soft
Occurrence rate of PG is most commonly on the gingiva in consistency, non-mobile, afebrile, non-tender with no thrill
(almost 75%) and other affected sites being dorsum of the and blanched on the application of pressure. There was no
tongue, buccal mucosa, and lips.[2] The present case reports with fluctuation, translucency, or indentation associated with the
an unusual location of PG on the ventral surface of the tongue. lesion.
Based on history and clinical examination, a provisional
Case Report diagnosis of PG was given, and surgical excision under local
anesthesia was planned. Before surgery, written consent
A 12-year-old female reported to the Department of Pedodontics was obtained by the patient and also permission for usage of
and Preventive Dentistry of Sharavathi Dental College and images for academic purposes was obtained. Routine blood
Hospital with a chief complaint of growth below the tongue for investigations were within normal range.
6 months. No significant medical history was elicited by the patient. Perioral structures were prepared with betadine and the
The growth was first noticed 6 months back, and during this soft tissues were adequately anesthetized. The tip of the tongue
time period, it would spontaneously increase or decrease in size. was sutured and elevated upward to obtain the visibility of the
Since the past 1  month, the swelling appeared to be gradually lesion. A Bard-Parker blade number 15 was used for excision. An
increasing in size and caused discomfort to the patient during elliptical incision was given at the base of the lesion for its removal
speech and mastication. There was no pain associated with the [Figure 2]. Along with the excised lesion, 2 mm of healthy tissue
swelling. was also excised. The area was checked for remnants of tissue

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Hemangioma in rare location Rai, et al.

tags and granulation tissue. After which copious irrigation with The presence of moderate calculus accounts for the chronic
povidone-iodine was done and interrupted sutures were placed irritation of the mucosa of the ventral surface of the tongue. The
with 3–0 silk [Figure  3]. The excised lesion was stored in a presence of these two factors synergistically can be considered as
formalin solution and sent for histopathological examination etiological factors of the PG. PG is an inflammatory hyperplasia
[Figure 4]. affecting the oral tissues possibly caused by the presence of
The patient was then recalled after 1 week for suture removal. calculus and foreign material.[5] Due to the raised level of sex
2 weeks later, the patient showed healing of the excised area with
the absence of any post-operative complications.

Discussion
The rate of occurrence of PG is between 26.8% and 32% and is
seen mostly in all age groups mostly between 11 and 40 years.[3]
Pathogenesis of the occurrence of PG is unclear; however, many
factors such as trauma ,chronic irritation and hormonal changes
have been suggested. The incidence of the occurrence of PG
is more in females than males in the ratio 3:2.[4] In the present
case, PG was diagnosed in 13-year-old female patient. Menarche
can be one of the reasons for the occurrence of the lesion in this
case as changes in hormonal levels occurs during this phase.

Figure 3: Excised specimen

Figure 1: Pre-operative view of the lesion Figure 4: Interrupted sutures placed

Figure  5: Histopathological section showing proliferating blood

Figure 2: Excisional biopsy of the lesion vessels with mixed inflammatory infiltrate in an edematous stroma

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Rai, et al. Hemangioma in rare location

hormone and progesterone in females, the occurrence of LCH investigation to rule out other neoplastic or non-neoplastic
is encountered more in females and similar features are seen in lesion. In the present case, the removal of the primary etiological
the present case. Thus, the presence of moderate calculus was factor, calculus, along with oral health education and follow-up
considered as primary etiological factor fuelled with hormonal lead to the successful clinical outcome.
changes caused the proliferating growth. Therefore, the patient
first underwent oral prophylaxis where the primary etiological
factor calculus was eliminated. Since the clinical presentation Clinical Significance
of PG is variable, it can mimic other oral lesions in children; Early diagnosis and treatment planning are the essence of
thus, differential diagnosis of fibroma, Kaposi’s sarcoma, surgery. As the adolescent patient’s value esthetics, it is the duty
metastatic tumor, bacillary angiomatosis, hemangiopericytoma, of the pedodontist to educate and motivate them.
and peripheral giant cell granuloma was made,[6,7] therefore
excisional biopsy of the lesion was done for confirmation. Final
diagnosis was made based on the histopathological report. References
Histopathological evaluation of the present case revealed 1. McDonald RE, David RA, Jeffrey AD. Dentistry for the Child
proliferating blood vessels with mixed inflammatory infiltrate in and Adolescent. 8th ed. New York: Mosby; 2004.
an edematous stroma [Figure 5]. Thus, histopathological report 2. Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic
is in accordance with the clinical finding. granuloma: A review. J Oral Sci 2006;48:167-75.
Two histological variants of PG have been described: LCH 3. Angelopoulos AP. Pyogenic granuloma of the oral cavity:
and non-LCH. In LCH, vessels are seen in lobular aggregates Statistical analysis of its clinical features. J  Oral Surg
with proliferating blood vessels with small luminal diameter. 1971;29:840-7.
Whereas in non-LCH, a vascular core resembling granulation 4. Skiner RL, Devenport WD Jr., Weir JC, Carr RF. A survey of biopsied
oral lesions in paediatric dental patient. Paediatr Dent 1986;8:163-7.
tissue with focal fibrous tissue is observed.[8] The histological
5. Punde PA, Malik SA, Malik NA, Parkar S. Idiopathic huge
finding in the present case showed similar finding as LCH.
pyogenic granuloma in young and old: An unusually large lesion
Surgical excision of the lesion was done using conventional in two cases. J Oral Maxillofac Pathol 2013;17:463-6.
technique which showed good prognosis with no post-operative 6. Fowler EB, Cuenin MF, Thompson SH, Kudryk VL, Bilmann MA.
complication. Other alternative techniques are cryosurgery, Pyogenic granuloma associated with guided tissue regeneration.
laser surgery with Nd: YAG, CO2, and flashlamp pulsed lasers.[9] A case report. J Periodontal 1996;67:1011-5.
Recurrence is rare but hormonal changes during puberty may 7. Amirchaghmaghi M, Farnaz F, Nooshin M, Mozafari PM. Extra
cause the lesion to reoccur.[10] Thus, follow-up in such cases is gingival pyogenic granuloma: A case report. Cases J 2008;1:371.
mandatory. 8. Marla V, Shrestha A, Goel K, Shrestha S. The Histopathological
spectrum of pyogenic granuloma: A case series. Case Rep Dent
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Conclusion 9. Moon SE, Hwang EJ, Cho KH. Treatment of pyogenic granuloma
with sodium tetradecyl sulphate scelerotherapy. Arch Dermatol
Many oral lesions may mimic other tumor-like lesions; thus, 2005;141:644-6.
patient’s history along with scrutiny of the etiological factors will 10. Singh H, Singh A, Shukla B, Das G, Agarwal N, Gauravi GS.
help us arrive at a definitive diagnosis which should be confirmed Pyogenic granuloma (lobular capillary hemangioma) of the
by proper laboratory investigations such as histopathological tongue: A case report. J Appl Dent Med Sci 2015;1:101-5.

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