60 years old non-diabetic female presented with about 5 mm erythematous papule at palm since last 3 weeks. She used corn cap for 3 days prior to consultation. Electrocautary was done and tissue was subjected to histopathology. Please suggest the diagnosis.

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Pyogenic Granuloma (Lobular Capillary Hemangioma) The term Pyogenic granuloma is misnamed. It is neither infectious nor granulomatous. Pyogenic granuloma (lobular capillary hemangioma) is a relatively common benign vascular lesion of the skin and mucosa whose exact cause is unknown. The lesion usually occurs in children and young adults as a solitary, glistening red papule or nodule that is prone to bleeding and ulceration. Pyogenic granulomas typically evolve rapidly over a period of a few weeks, most often on the head, neck, extremities, and upper trunk. Other pyogenic granuloma variants that have been well documented include the disseminated, subcutaneous, intravenous, and medication-induced (for example, retinoid, antiretroviral, and oncologic agent) subtypes. Differential diagnosis of Pyogenic granuloma; 1. Peripheral giant cell granuloma 2. Peripheral ossifying fibroma 3. Metastatic cancer 4. Hemangioma 5. Pregnancy tumor 6. Conventional granulation tissue hyperplasia 7. Kaposi's sarcoma 8. Bacillary angiomatosis 9. Non-Hodgkins lymphoma. A number of malignant tumors may clinically mimic pyogenic granuloma, making histopathologic confirmation important. Aside from cutaneous and oral lesions, pyogenic granuloma has been reported throughout the gastrointestinal tract and upper airway, at various ocular locations, the central nervous system, the bladder and the internal vasculature.

Pathophysiology of pyogenic granuloma. The precise mechanism for the development of pyogenic granuloma (lobular capillary hemangioma) is unknown. Trauma, hormonal influences, certain medications, viruses, underlying microscopic arteriovenous malformations, the production of angiogenic growth factors, and cytogenetic abnormalities have all been postulated to play a role. The overexpression of transcription factors P-ATF2 and STAT3 also may play a role in tumorigenesis. [2] Endothelial nitric oxide synthases (eNOS), CD34, and CD105/endoglin expression are markers of angiogenesis in pyogenic granulomas. [3, 4] . Tissue injury may trigger pathologic angiogenesis driven by FLT4, a tyrosine-kinase receptor, and the nitric acid pathway. [5] COX-2 and IL-10 may be involved in the etiopathogenesis of oral pyogenic granulomas. [6] BRAF and RAS mutations have been identified, suggesting a true neoplastic process. [7, 8]

Dr Jagirdar sir, If infection has no role how do u explain the infitration of poly amd monoctes? How r inflamatory luecotrines( like Il 6) are produced and involve in pathogenedis ? Pogenic granuloma often responds to Antibiotics. How can a vascular tumor respond ? GP is very friable and bleeds on its own and on slightest trauma. Does a vascular tumor like haemangioma behave the same way.? The source of what u and I quoted(pathophysiology) is 2017 mediscope article. Should we dubscribe to this isolated story about granuloma pyogenicum is not related to infection and infact a vascular tumor as against what is taught till 2016 ?. Pl guide me Sir.

Dear Dr Asv Prasad Thanking you for reviewing this work. GP may be entity caused by multiple causes. The factors, known as well as unknown, lead to this entity called GP. Not only in GP many diseases we hardly know. with regards
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Nice and sophisticated work Sir. After cautery usually nobody bothers about hpe. Good show Sir. Thanks for sharing.