scholarly journals Gastrointestinal Pyogenic Granuloma (Lobular Capillary Hemangioma): An Underrecognized Entity Causing Iron Deficiency Anemia

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Marshall W. Meeks ◽  
Umar M. Kamal ◽  
Muhammad B. Hammami ◽  
Jason R. Taylor ◽  
M. Louay Omran ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Iron Deficiency ◽  
Case Series ◽  
Pyogenic Granuloma ◽  
Vascular Tumor ◽  
Capillary Hemangioma ◽  
Deficiency Anemia ◽  
Review Of The Literature ◽  
Lobular Capillary Hemangioma ◽  
Actual Incidence

Pyogenic granuloma (PG), more accurately known as lobular capillary hemangioma, is a benign vascular tumor that usually occurs in the skin or oral mucosa. This lesion is rarely reported in the gastrointestinal tract but is known to bleed if not resected. We herein describe a case series with the clinical, endoscopic, and histologic findings of four cases of gastrointestinal PG at our institution. In addition, we provide a review of the literature and summation of all reported cases of PG specific to the gastrointestinal tract. Based on our experience, we suggest that the actual incidence of gastrointestinal PG may in fact be higher than reported because PG can be unrecognized or improperly diagnosed. It is important for the clinician to properly recognize this lesion as a source of anemia and its propensity to bleed during biopsy or resection.

Three Cases of Pyogenic Granuloma of the Gastrointestinal Tract

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S119-S119
Author(s):  
Yukihiro Nakanishi ◽  
Preeti Behl ◽  
Byron Crawford
Keyword(s):  
Gastrointestinal Tract ◽  
Pyogenic Granuloma ◽  
Right Hemicolectomy ◽  
Capillary Hemangioma ◽  
Deficiency Anemia ◽  
Significant Drop ◽  
Massive Gastrointestinal Bleeding ◽  
History Of ◽  
Mixed Inflammatory Infiltrate ◽  
Pedunculated Polyp

Abstract Pyogenic granuloma also known as lobular capillary hemangioma occurs commonly in the skin and oral mucosa. This entity has been rarely reported in the gastrointestinal tract. We herein report three cases of pyogenic granuloma, located in the duodenum, ileum, and rectum, respectively. Case 1 is a 54-year-old female with a history of angioimmunoblastic T-cell lymphoma who underwent an esophagogastroduodenoscopy for severe heartburn. The endoscopy showed a 13-mm nonbleeding, pedunculated polyp in the second portion of duodenum, which was removed using a hot snare after injection of epinephrine. The patient had an episode of massive gastrointestinal bleeding postpolypectomy, with a significant drop of her hemoglobin, which was managed with blood transfusion. Case 2 is a 68-year-old male with a history of right hemicolectomy due to trauma who had a colonoscopy for chronic diarrhea. The colonoscopy revealed a 14-mm, nonbleeding, pedunculated polyp in the ileum, located 3 cm from the ileocolonic anastomosis. The polyp was removed with hot snare, without complications. Case 3 is a 44-year-old female with morbid obesity who underwent a colonoscopy for iron-deficiency anemia. The colonoscopy showed an 8-mm multilobulated sessile lesion in the distal rectum, which was completely removed using hot snare. No complications were seen postpolypectomy. Histological examination of all the three polyps showed a proliferation of capillary-sized blood vessels with a mixed inflammatory infiltrate, resembling granulation tissue. Additionally, the ileal polyp in our case had marked eosinophilic infiltrate, the etiology of which remains unknown. In conclusion, pyogenic granuloma, given its vascular nature, can be a cause of bleeding in the gastrointestinal tract. Awareness regarding this rare entity is important for its proper diagnosis and treatment.

scholarly journals The Histopathological Spectrum of Pyogenic Granuloma: A Case Series

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Vinay Marla ◽  
Ashish Shrestha ◽  
Khushboo Goel ◽  
Sajeev Shrestha
Keyword(s):  
Endothelial Cells ◽  
Clinical Course ◽  
Age Groups ◽  
Case Series ◽  
Pyogenic Granuloma ◽  
Capillary Hemangioma ◽  
Lobular Capillary Hemangioma ◽  
Case Presentation ◽  
Solitary Nodule ◽  
Slow Growing

Background.Pyogenic granuloma is a reactive tumor-like lesion commonly affecting the oral cavity. These lesions usually appear as localized solitary nodule with a sessile or pedunculated base and colour varying from red, purplish, or pink, depending on the vascularity of the lesion. Pyogenic granuloma shows predilection for gingiva and is usually slow growing, but at times it shows rapid growth. The natural course of this lesion can be categorized into three distinct phases, namely, (i) cellular phase, (ii) capillary phase/vascular phase, and (iii) involutionary phase. Histopathologically, pyogenic granuloma is classified into lobular capillary hemangioma (LCH) and non-lobular capillary hemangioma (non-LCH).Case Presentation. In this series, four cases (varied age groups and both genders) of pyogenic granuloma showing varying histopathological presentation in relation to its clinical course have been described. The lesion in its early phase reveals diffuse endothelial cells, with few budding into capillaries. Among the capillary phase, the LCH type shows numerous blood vessels organized into lobular aggregates whereas the non-LCH type does not show any such organization and resembles granulation tissue. The involutionary phase shows healing of the lesion and is characterized by extensive fibrosis in the connective tissue.Conclusion.In conclusion, knowledge of the various histopathological presentation of this lesion is necessary for proper identification.

scholarly journals Pediatric Nasal Lobular Capillary Hemangioma

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Jordan M. Virbalas ◽  
John P. Bent ◽  
Sanjay R. Parikh
Keyword(s):  
Nasal Obstruction ◽  
Pediatric Population ◽  
Case Series ◽  
Epidemiological Data ◽  
Pyogenic Granuloma ◽  
Capillary Hemangioma ◽  
Retrospective Case ◽  
Lobular Capillary Hemangioma ◽  
Image Guided ◽  
Recurrent Epistaxis

Background.LCH is a benign vascular growth of the skin and mucous membranes commonly affecting the head and neck. Since it was first described in the nineteenth century, this entity has been variously known as “human botryomycosis” and “pyogenic granuloma.” The shifting nomenclature reflects an evolving understanding of the underlying pathogenesis. We review the histopathology of and current epidemiological data pertaining to LCH which suggests that the development of these lesions may involve a hyperactive inflammatory response influenced by endocrine factors. We report two new cases of pediatric lobular capillary hemangioma (LCH) of the nasal cavity and review current theories regarding the etiology, diagnosis, and treatment of nasal LCH.Methods. Retrospective case series.Case Series. Two adolescent females presented with symptoms of recurrent epistaxis, nasal obstruction, and epiphora. Both patients underwent computed tomography imaging and biopsy of their intranasal mass. The tumors were excised using image-guided transnasal endoscopic technique. Seven other cases of nasal LCH have been reported to date in the pediatric population.Conclusion. Nasal LCH is a rare cause of an intranasal mass and is associated with unilateral epistaxis, nasal obstruction, and epiphora. We advocate for image-guided endoscopic excision of LCH in the adolescent population.

OCCULT BLOOD LOSS IN IRON DEFICIENCY ANEMIA OF INFANCY

PEDIATRICS ◽  
1961 ◽  
Vol 27 (2) ◽  
pp. 199-203
Author(s):  
M. Silvija Hoag ◽  
Ralph O. Wallerstein ◽  
Myron Pollycove
Keyword(s):  
Early Childhood ◽  
Gastrointestinal Tract ◽  
Iron Deficiency ◽  
Blood Loss ◽  
Iron Deficiency Anemia ◽  
Whole Blood ◽  
Occult Blood ◽  
Deficiency Anemia ◽  
Observation Period

Blood loss from the gastrointestinal tract was measured in 13 infants with iron deficiency anemia, using radioiron as a tracer. The radioiron was given intravenously; radioactivity in the erythrocytes and feces was measured for the following 3 to 4 weeks. The percentage of total Fe administered that was recovered in the stools varied between 0.75 and 16.4%, with a mean of 5.75%. This represents loss of whole blood in the stools varying from 7 to 107 ml, with a mean of 41 ml during the observation period. Occult blood loss from the gastrointestinal tract appears to be a significant factor in the development of iron deficiency in early childhood.

scholarly journals Upper Gastrointestinal Crohn’s Disease: Literature Review and Case Presentation

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Soorya N. Aggarwal ◽  
Yana Cavanagh ◽  
Lan Wang ◽  
Amer Akmal ◽  
Matthew A. Grossman
Keyword(s):  
Crohn’S Disease ◽  
Gastrointestinal Tract ◽  
Iron Deficiency ◽  
Crohn's Disease ◽  
Fecal Calprotectin ◽  
Upper Gastrointestinal Tract ◽  
Laboratory Evaluation ◽  
Deficiency Anemia ◽  
Endoscopic Evaluation ◽  
Upper Gastrointestinal

Upper gastrointestinal tract predominant Crohn’s Disease (CD) remains an elusive clinical entity, manifesting limited or vague symptomatology, eluding clinical suspicion, and delaying subsequent diagnostic evaluation. As a result, it has not been widely described and there is a lack of clear recommendations for diagnosis or management. Standard IBD evaluation including serologic testing, imaging, and endoscopy may initially not be fruitful. Furthermore, endoscopic evaluation may be grossly normal in patients without long standing-disease. We describe an 18-year-old male who presented with only unexplained, persistent iron-deficiency anemia. Extensive outpatient testing including multiple endoscopic evaluations with standard biopsies was unfruitful. Ultimately, a positive fecal calprotectin prompted enteroscopy with endoscopic mucosal resection (EMR) in an effort to obtain a larger, deeper tissue specimen. Grossly cobblestoned mucosa along with histopathology revealing focal crypt abscesses, chronic inflammation in the lamina propria, and superficial foveolar epithelial regenerative changes were consistent with CD. This patient’s case illustrates the need for a high degree of suspicion for CD in patients with unexplained or persistent iron deficiency anemias. Persistent investigation yielded an elevation in fecal calprotectin suggesting underlying gastrointestinal inflammation and prompted advanced endoscopic evaluation with EMR. Waxing and waning tissue findings are characteristic of CD and pose a unique challenge in patients with upper gastrointestinal predominant pathology. As such, diligent workup including laboratory evaluation, imaging, and serial endoscopy is critical to establish pathology and dictate subsequent management in IBD, especially upper gastrointestinal tract predominant CD.

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