Background: Pyogenic granuloma (PG), a vascular tumor, have problems, such as how its pathogenesis is unknown, the name is not unified, and reported duplicate tumors, associated with it. In this study, we report a patient with PG who partially presented with racemose hemangioma-like findings.
Case: A 76-year-old man presented to a local physician with complaints of intermittent bleeding from the right conjunctiva and prolapse of the mass. He underwent resection, but the bleeding did not stop; therefore, he was urgently referred to Nihonmatsu Eye Hospital. A mushroom-like mass was observed on the right upper eyelid conjunctiva, and the umbrella part was round and covered with white moss. Conversely, dark-red blood vessels chaotically intertwined in the stem. Since the clinical findings were different between the umbrella and stem parts, overlap with the racemose hemangioma was suspected, and total resection including the base eyelid plate was performed. Histopathological examination showed that both the umbrella and stem parts were composed of lobular capillary hemangioma of chronic inflammatory cells and plump endothelial cells, along with the presence of edematous granulation tissue with collagen fiber bundles. Based on these findings, the patient was diagnosed with PG. However, the lobules had developed deep below the fibrin layer in the umbrella part, while in the stem part, they existed in the surface layer just below the epithelium.
Conclusions: The reason why the blood vessels in the stem part in this case were dilated and enlarged was that they were not subjected to pressure from the surroundings. In patients with PG who experience lobular hemangioma, the clinical findings may change from patient to patient depending on the location of the presence and surrounding conditions. It may be difficult to differentiate PG from duplicate tumors and decide on a treatment plan.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 128：341-347, 2024.