Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-17T01:43:14.245Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of pregnancy-associated oral pyogenic granuloma with life-threatening haemorrhage by transarterial embolisation

Published online by Cambridge University Press:  15 June 2015

K-Y Tsai ,
W-H Wang ,
G-H Chang  and
Y H Tsai
K-Y Tsai
Affiliation:
Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan, ROC
W-H Wang*
Affiliation:
Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan, ROC Department of Otolaryngology, Sijhih Cathay General Hospital, New Taipei City, Taiwan, ROC Fu-Jen Catholic University School of Medicine, New Taipei City, Taiwan, ROC
G-H Chang
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Taiwan, ROC
Y H Tsai
Affiliation:
Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Taiwan, ROC
*
Address for correspondence: Dr W-H Wang, Department of Otolaryngology – Head and Neck Surgery, Cathay General Hospital and Fu-Jen Catholic University School of Medicine, 280 Jen-Ai Road, Sec. 4, Taipei 10630, Taiwan, ROC E-mail: ent.taiwan@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Pregnancy-associated pyogenic granuloma (pregnancy tumour) is not uncommon. However, control of severe bleeding associated with the lesion by transarterial embolisation has never been reported.

Case report:

We report the case of a 33-year-old pregnant woman (34 weeks gestation) who presented with a pregnancy-associated pyogenic granuloma of the mandibular gingiva with a life-threatening haemorrhage. The bleeding stopped soon after transarterial micro-embolisation and regressed after one month; thus, no further surgical excision was needed. The patient was free of post-operative wound pain and infection, and there was no recurrence after one year of follow up.

Conclusion:

In general, surgical excision is the first treatment choice for pregnancy tumours. However, it is limited by the risk of marked deformity or incomplete excision when large lesions or difficult surgical areas are encountered. For large tumours, transarterial embolisation may be a safer alternative.

Keywords

Granuloma, PyogenicPregnancy ComplicationsTherapeutic EmbolizationHemorrhage
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 6 , June 2015 , pp. 607 - 610
Copyright
Copyright © JLO (1984) Limited 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Eversole, LR. Clinical Outline of Oral Pathology: Diagnosis and Treatment, 3rd edn.Hamilton, Ontario: BC Decker, 2002;113–14Google Scholar
2Neville, BW, Damm, DD, Allen, CM, Bouquot, JE. Oral and Maxillofacial Pathology, 2nd edn.Philadelphia: WB Saunders, 2002;437–95Google Scholar
3Regezi, JA, Sciubba, JJ, Jordan, RCK. Oral Pathology: Clinical Pathologic Considerations, 4th edn, Philadelphia: WB Saunders, 2003;115–16Google Scholar
4Gordón-Núñez, MA, de Vasconcelos Carvalho, M, Benevenuto, TG, Lopes, MF, Silva, LM, Galvão, HC. Oral pyogenic granuloma: a retrospective analysis of 293 cases in a Brazilian population. J Oral Maxillofac Surg 2010;68:2185–8CrossRefGoogle Scholar
5Saravana, GH. Oral pyogenic granuloma: a review of 137 cases. Br J Oral Maxillofac Surg 2009;47:318–19CrossRefGoogle ScholarPubMed
6Lawoyin, JO, Arotiba, JT, Dosumu, OO. Oral pyogenic granuloma: a review of 38 cases from Ibadan, Nigeria. Br J Oral Maxillofac Surg 1997;5:185–9CrossRefGoogle Scholar
7Hamid, J, Majid, S, Nooshin, M. Oral pyogenic granuloma: a review. J Oral Science 2006;4:167–75Google Scholar
8Shimizu, K, Naito, S, Urata, Y, Sekine, I, Kondo, T, Katayama, I. Inducible nitric oxide synthase is expressed in granuloma pyogenicum. Br J Dermatol 1998;138:769–73CrossRefGoogle ScholarPubMed
9Bragado, R, Bello, E, Requena, L, Renedo, G, Texeiro, E, Alvarez, MV et al. Increased expression of vascular endothelial growth factor in pyogenic granulomas. Acta Derm Venereol 1999;79:422–5Google ScholarPubMed
10Hagiwara, K, Khaskhely, NM, Uezato, H, Nonaka, S. Mast cell ‘densities’ in vascular proliferations: a preliminary study of pyogenic granuloma, portwine stain, cavernous hemangioma, cherry angioma, Kaposi's sarcoma, and malignant hemangioendothelioma. J Dermatol 1999;26:577–86CrossRefGoogle ScholarPubMed
11Igarashi, A, Hayashi, N, Nashiro, K, Takehara, K. Differential expression of connective tissue growth factor gene in cutaneous fibrohistiocytic and vascular tumours. J Cutan Pathol 1998;25:143–8CrossRefGoogle Scholar
12Vassilopoulos, SI, Tosios, KI, Panis, VG, Vrotsos, JA. Endothelial cells of oral pyogenic granulomas express eNOS and CD105/endoglin: an immunohistochemical study. J Oral Pathol Med 2011;40:345–51CrossRefGoogle ScholarPubMed
13Yuan, K, Jin, YT, Lin, MT. The detection and comparison of angiogenesis-associated factors in pyogenic granuloma by immunohistochemistry. J Periodontol 2000;71:701–9CrossRefGoogle ScholarPubMed
14Whitaker, SB, Bouquot, JE, Alimario, AE, Whitaker, TJ Jr. Identification and semiquantification of estrogen and progesterone receptors in pyogenic granulomas of pregnancy. Oral Surg Oral Med Oral Pathol 1994;78:755–60CrossRefGoogle ScholarPubMed
15Effiom, OA, Adeyemo, WL, Soyele, OO. Focal Reactive lesions of the Gingiva: An Analysis of 314 cases at a tertiary Health Institution in Nigeria. Niger Med J 2011;52:35–40Google Scholar
16Chamani, G, Navabi, N, Abdollahzadeh, S. Prevalence of pregnancy tumor in pregnant women. Shiraz Univ Dent J 2009;10:79–82Google Scholar
17Sills, ES, Zegarelli, DJ, Hoschander, MM, Strider, WE. Clinical diagnosis and management of hormonally responsive oral pregnancy tumour (pyogenic granuloma). J Reprod Med 1996;41:467–70Google ScholarPubMed
18Wang, PH, Chao, HT, Lee, WL, Yuan, CC, Ng, HT. Severe bleeding from a pregnancy tumour. A case report. J Reprod Med 1997;42:359–62Google ScholarPubMed
19Bouquot, JE, Nikai, H. Lesions of the oral cavity. In: Gnepp, DR, ed. Diagnostic Surgical Pathology of the Head and Neck. Philadelphia: WB Saunders, 2001;141–233Google Scholar
20Greenberg, MS, Glick, M. Burket's Oral Medicine: Diagnosis and Treatment, 10th edn.Hamilton, Ontario: BC Decker, 2003;141–2Google Scholar
21Krishnapillai, R, Punnoose, K, Angadi, PV, Koneru, A. Oral pyogenic granuloma-a review of 215 cases in a South Indian Teaching Hospital, Karnataka, over a period of 20 years. Oral Maxillofac Surg 2012;16:305–9CrossRefGoogle Scholar
22Taira, JW, Hill, TL, Everett, MA. Lobular capillary hemangioma (pyogenic granuloma) with satellitosis. J Am Acad Dermatol 1992;27:297–300CrossRefGoogle ScholarPubMed
23Oliveira, TM, Greghi, SL, Taveria, LA, Santos, CF, Machado, MA, Silva, SM. Surgical removal of an oral pyogenic granuloma and subsequent root coverage with a pedicle graft. J Dent Child (Chic) 2008;75:55–8Google ScholarPubMed
24Nemcovsky, CE, Moses, O, Artzi, Z. Gingival reconstruction with an onlay-interpositional graft following excision of a pyogenic granuloma: description of a surgical approach. Pract Proced Aesthet Dent 2003;15:173–6Google ScholarPubMed
25Lindenmüller, IH, Noll, P, Mameghani, T, Walter, C. CO2 laser-assisted treatment of a giant pyogenic granuloma of the gingiva. Int J Dent Hyg 2010;8:249–52CrossRefGoogle ScholarPubMed
26Hammes, S, Kaiser, K, Pohl, L, Metelmann, HR, Enk, A, Raulin, C. Pyogenic granuloma: treatment with the 1,064-nm long-pulsed neodymium-doped yttrium aluminum garnet laser in 20 patients. Dermatol Surg 2012;38:918–23CrossRefGoogle Scholar
27Powell, JL, Bailey, CL, Coopland, AT, Otis, CN, Frank, JL, Meyer, I. Nd:YAG laser excision of a giant gingival pyogenic granuloma of pregnancy. Lasers Surg Med 1994;14:178–833.0.CO;2-W>CrossRefGoogle ScholarPubMed
28Meffert, JJ, Canga, DR, Meffert, RM. Treatment of oral granulation tissue with flashlamp pulsed dye laser. Dermatol Surg 1998;24:845–8CrossRefGoogle ScholarPubMed
29Khandpur, S, Sharma, VK. Successful treatment of multiple gingival pyogenic granulomas with pulsed-dye laser. Indian J Dermatol Venereol Leprol 2008;74:275–7CrossRefGoogle ScholarPubMed
30Ishida, CE, Ramos-e-Silva, M. Cryosurgery in oral lesions. Int J Dermatol 1998;37:283–5CrossRefGoogle ScholarPubMed
31Ichimiya, M, Yoshikawa, Y, Hamamoto, Y, Muto, M. Successful treatment of pyogenic granuloma with injection of absolute ethanol. J Dermatol 2004;31:342–4CrossRefGoogle ScholarPubMed
32Moon, SE, Hwang, EJ, Cho, KH. Treatment of pyogenic granuloma by sodium tetradecyl sulfate sclerotherapy. Arch Dermatol 2005;141:644–6CrossRefGoogle ScholarPubMed
33Matsumoto, K, Nakanishi, H, Seike, T, Koizumi, Y, Mihara, K, Kubo, Y. Treatment of pyogenic granuloma with a sclerosing agent. Dermatol Surg 2001;27:521–3Google ScholarPubMed
34Parisi, E, Glick, PH, Glick, M. Recurrent intraoral pyogenic granuloma with satellitosis treated with corticosteroids. Oral Dis 2006;12:70–2CrossRefGoogle ScholarPubMed
35Adenis-Lamarre, E, Fricain, JC, Tabrizi, R, Turlure, P, Milpied, N, Beylot-Barry, M. Massive pyogenic granuloma of the oral cavity during chronic graft-versus-host disease: treatment with local triamcinolone injection. Ann Dermatol Venereol 2009;136:818–20CrossRefGoogle ScholarPubMed
36Loureiro, CC, Falchet, PC, Gavranich, J Jr, Lobo Leandro, LF. Embolization as the treatment for a life-threatening mandibular arteriovenous malformation. J Craniofac Surg 2010;21:380–2CrossRefGoogle ScholarPubMed
37Murono, S, Nakanishi, Y, Inoue, D, Ozaki, K, Kondo, S, Wakisaka, N et al. Pseudoaneurysm of the lingual artery after concurrent intra-arterial chemotherapy with radiotherapy for advanced tongue cancer. Head Neck 2011;33:1230–2CrossRefGoogle ScholarPubMed
38Kaneko, R, Tohnai, I, Ueda, M, Negoro, M, Yoshida, J, Yamada, Y. Curative treatment of central hemangioma in the mandible by direct puncture and embolisation with n-butyl-cyanoacrylate (NBCA). Oral Oncol 2001;37:605–8CrossRefGoogle ScholarPubMed
39Marden, FA, Calilao, GC, Guzman, G, Roy, SS. Glossal angiomyoma: imaging findings and endovascular treatment. Head Neck 2004;26:1084–8CrossRefGoogle ScholarPubMed
40Kumar, VV, Malik, NA, Kumar, DB. Treatment of large recurrent aneurysmal bone cysts of mandible: transosseous intralesional embolization as an adjunct to resection. Int J Oral Maxillofac Surg 2009;38:671–6CrossRefGoogle ScholarPubMed