Pyogenic Granuloma Histology — ORE Part 1 MCQ

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ModerateOral PathologyPyogenic Granuloma HistologyORE Part 1

A 25-year-old woman who is 28 weeks pregnant presents with a rapidly enlarging gingival mass between the upper right lateral incisor and canine. The lesion is red, bleeds readily and interferes with eating. Histological examination shows ulcerated mucosa overlying lobules of capillary-sized vessels in an inflamed granulation-tissue stroma. What is the most likely diagnosis?

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Correct answer: C — Pyogenic granuloma

**A. Pyogenic granuloma** is correct. Pregnancy, a gingival site, rapid enlargement and easy bleeding are typical clinical features. Crucially, the biopsy shows lobules of capillary-sized vessels: the defining vascular architecture of pyogenic granuloma, also termed lobular capillary haemangioma. Ulceration, inflammation and granulation-tissue change may be present superficially. **B** would contain numerous multinucleated giant cells, usually with haemorrhage and haemosiderin. **C** is a reactive fibrous lesion with collagenised stroma, not lobular vascular proliferation. **D** would show dysplastic malignant epithelium invading connective tissue. **E** is characterised by spindle-cell proliferation with slit-like vascular spaces and is not the typical pregnancy-associated gingival lesion.

Reference: Mills SE, Cooper PH, Fechner RE. Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes. American Journal of Surgical Pathology, 1980. https://pubmed.ncbi.nlm.nih.gov/7435775/