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PHOTO ESSAY
Year : 2020  |  Volume : 68  |  Issue : 8  |  Page : 1645-1646

A rare case of symptomatic ocular pyogenic granuloma in pregnancy


Dr. Agarwal Eye Hospital and Eye Research Centre, Chennai, India

Date of Submission04-Dec-2019
Date of Acceptance10-Mar-2020
Date of Web Publication24-Jul-2020

Correspondence Address:
Dr. Dhivya Ashok Kumar
Dr. Agarwalfs Eye Hospital and Eye Research Centre, 222, TTK Road, Chennai - 600 018, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2239_19

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  Abstract 


Keywords: Lobular capillary hemangioma, pregnancy, pyogenic granuloma


How to cite this article:
Ashok Kumar D, Thajudeen H, Agarwal A. A rare case of symptomatic ocular pyogenic granuloma in pregnancy. Indian J Ophthalmol 2020;68:1645-6

How to cite this URL:
Ashok Kumar D, Thajudeen H, Agarwal A. A rare case of symptomatic ocular pyogenic granuloma in pregnancy. Indian J Ophthalmol [serial online] 2020 [cited 2020 Aug 11];68:1645-6. Available from: http://www.ijo.in/text.asp?2020/68/8/1645/290429



A 23-year-old primigravida (37 weeks) complained of bleeding from the right eye for 15 days. The patient denied any history of trauma or surgery. On examination, the right upper lid revealed a well-defined, nontender, red, polypoidal smooth-surfaced 5 mm mass in the palpebral conjunctiva with active bleeding [Figure 1]. Visual acuity was 20/20 in both eyes and fundus was normal. After gynecologist consultation and basic systemic workup (bleeding time 3 minutes and clotting time 6 minutes), she underwent excision biopsy [Figure 2]a and [Figure 2]b with cauterization of the base under 0.5 cc local infiltration of 2% lignocaine. The histopathology showed a lesion with lobules of thin-walled vessels with intervening stromal foci of lymphoplasmacytic infiltration [Figure 3].
Figure 1: Actively bleeding upper palpebral conjunctival mass lesion on the day of presentation

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Figure 2: Inactive mass on the day of surgery (a) and after excision with base cautery (b)

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Figure 3: Histopathology micrograph with 10X magnification stained with Haematoxylin and eosin of lobulated capillary hemangioma. The histopathology showed fibro-collagenous tissue covered by mucosa, epithelium showed acanthosis and areas of ulceration and dermis showed a lesion with lobules of thin walled vessels with intervening stromal foci of lymphoplasmacytic infiltration

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  Discussion Top


Angelopoulos AP described the lesion as “Hemangiomatous Granuloma” due to the presence of numerous blood vessels and inflammatory pictures histologically.[1] In a case series of 7 pregnant women who developed hemangiomas during pregnancy, it was proposed that hormonal alterations, changes in blood volume contributed to their occurrence.[2] Yuan et al. described the relationship between pyogenic granulomas and angiogenic factors in pregnancy.[3] According to the authors, female hormones not only enhance the expression of angiogenic factors such as basic fibroblast growth factor (FGF) and vascular endothelial growth factor (VEGF) but also decrease cell apoptosis by lessening the expression of tissue necrosis factor-alpha (TNF-alpha).[4] A pregnancy tumor has a prevalence of 0.2–9.6% during gravidity.[5] They commonly appear after the first trimester, grow rapidly, and typically regress after delivery. Complete excision with Histopathological examination (HPE) is the treatment of choice in persistent lesions with bleeding, painful or excessively large. The overall risk of recurrence is about 7% more following prior surgery and warrants close monitoring. The case thus highlights the management of a distressing lid hemangioma in a third-trimester primigravida.

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Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Angelopoulos AP. Pyogenic granuloma of the oral cavity: Statistical analysis of its clinical features. J Oral Surg 1971;29:840-7.  Back to cited text no. 1
    
2.
Barter RH, Letterman GS, Schurter M. Hemangiomas in pregnancy. Am J Obst Gynec 1963;87:625-35.  Back to cited text no. 2
    
3.
Yuan K, Wing LY, Lin MT. Pathogenetic roles of angiogenic factors in pyogenic granulomas in pregnancy are modulated by female sex hormones. J Periodontol 2002;73:701-8.  Back to cited text no. 3
    
4.
Al-Towerki AA. Pyogenic Granuloma. Int Ophthalmol 1995-1996;19:287-91.  Back to cited text no. 4
    
5.
Reddy NR, Kumar PM, Selvi T, Nalini HE. Management of recurrent post-partum pregnancy tumor with localized chronic periodontitis. Int J Prev Med 2014;5:643-7.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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