|Year : 1982 | Volume
| Issue : 2 | Page : 103-106
A Panda, IM Bhatia, NK Pattnaik
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S. New Delhi, India
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Panda A, Bhatia I M, Pattnaik N K. Granuloma pyogenicum. Indian J Ophthalmol 1982;30:103-6
Granuloma pyogenicum is a rare condition. It may appear on any part of the skin, frequently occurs on hand & arms following insignificant trauma or previous infection. It's tendency to bleed, rapid growth and recurrence after incomplete excision often lead to misdiagnosis of a malignant neoplasm. It's occurrence over palpebral conjunctiva and over a primary pterygium was well documented,. The same on the lids is infrequent but if it occurs, pre-direction is for the lower lid. The occurrence over an excised pterygium and in an enucleated socket was described in the literature'.
The purpose of this paper is to document twelve cases of granuloma pyogenicum, the location of the growth had been variable. The aetiopathogenesis of the condition has been discussed at length.
| Composite clinical summary|| |
Twelve patients in this study were described. The age of presentation ranged from 7-31 years, the male : female ratio being 2 : l.
In general the history was that of a growth either over the eyeball, or on an exenterated socket or over the upper eyelid (both from skin & conjunctival side). Six of the patients had the history of trauma of varied type [Figure - 1][Figure - 2]. In three cases where there was no history of operation, the pre-operative diagnosis was chalazion in two while the third was considered to be having sebaceous cyst. In yet another case diagnosis returned as pterygium over which a growth had developed [Figure - 3][Figure - 4]. In last two cases no definite history could be obtained [Table - 1]. In this series there was no predilection for a particular site. The site of involvement is as shown in [Table - 2]. In all the cases surgical excision was carried out.
The follow up period in our series ranged from three months to 32 years. In no case was there clinical evidence of recurrence.
| Microscopic findings|| |
On histological examination all the specimens revealed almost similar appearance. It is a polypoidal lesion covered with conjunctiva, which is going downwards and forming a collerate at the base. The lesion shows large number of newly formed capillaries. These were dilated and lined by prominent endothelial cells. The stroma is oedematosus. In all the resected specimens, varying amount of inflammatory infiltrate consisting of plasma cells, lymphocytes, eosinophils and polymorphonuclear cells, is present in the stroma.
| Discussion|| |
The occurrence of granuloma pyogenicum in dermatological practice is quite common but the ophthalmic involvement is very rare.
The aetiology of this condition is obscure. Various factors like major trauma, subclinical infections or inflammations or previous surgery are blamed. Fungal and bacterial infections of the nature of Botryomycosis and staphylococcus aureus respectively have been incriminated by various authors.
In our first case the patient was operated for pterygium, second had alkali burn followed by numerous surgical interventions, third manifested in an exenterated socket, fourth, fifth and ninth, had no such history and were diagnosed clinically as either chalazion or sebaceous cyst. The sixth case was operated for ptosis (operation performed from the skin side and the granuloma occurred on conjunctival side. The possibility of bottom holding of conjunctiva has to be considered, however previous operation notes did not tend to favour the same. Seventh case and eighth had accidental injury and the last case bad developed a growth over an existing pterygium. While from tenth case and eleventh case no definite history could he obtained.
The lack of history of a previous chalazion, or other inflammatory entity and the absence of an infection on clinical as well as microbiological examination in six of our cases (50%) would tend to go against the hypothesis of infection or inflammation. It therefore, appears likely that the lesions arose denovo from an unknown stimulus. However, our series is too small to draw firm conclusions over this.
Regarding the location it was also variable. Though upper lid is very rare to be involved, we had five cases of such involvement in our series [Table - 2]
There is preponderance of the involvement of the males thus supporting the views of Friedman and Henkind.
The treatment of this condition is excision. Both electro-desiccation and excision are the best ways to treat these lesions. The diagnosis of the lesion is made microscopically following biopsy. The lesion is differentiated histologically from hemangiopericytoma by the lack of `Mantle' of pericytes around the capillaries. As the lesions described in our series as well as in the literature,,,, mimic so many other diseases pre-operatively both benign and malignant, a histopathological examination of the tissue is very much essential for confirmation of the diagnosis before undertaking any decision of enucleation of globe, or otherwise.
| Summary|| |
Twelve cases of Granuloma Pyogenicum are described. The various aetiology, site of location, presenting symptoms and management are discussed. No recurrence of the growth was seen during follow up period of 3 months to 32 years.
| References|| |
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Duke Elders, S. 1974, System of Ophthalmology Vol. 13, Part 1, Page 501, Henry Kimpton, London.
Hari Mohan and Gupta A.N. 1968, Amer J.Ophthalmol. 65: 619.
Friedman, A.H. and Henkind, P., 1971, Amer J. Ophthalmol. 71 :868.
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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
[Table - 1], [Table - 2]