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Agminated Pyogenic Granuloma–Like Growth Arising in a Congenital Hemangioma

Benjamin Barrick, DO1; Julia Lehman, MD2; Megha Tollefson, MD2
[+] Author Affiliations
1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
2Department of Dermatology, Mayo Clinic, Rochester, Minnesota
JAMA Dermatol. 2014;150(7):781-783. doi:10.1001/jamadermatol.2013.7530.
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Pyogenic granulomas (PGs), usually solitary and isolated, have rarely been reported to arise as lesions within preexisting vascular malformations.1 Multiple, distinct, PG-like lesions within capillary or arteriovenous malformations (AVMs) have been described.2 To our knowledge, no cases of solitary or agminated PG-type growths have been reported in congenital hemangiomas (CHs).

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Figure 1.
Clinical Photographs of Patient

A, Violaceous plaque on the right jawline at first presentation. B, Patient presented 3 months later with bleeding and new growth associated with pain at the superior pole of the lesion. C, Recurrence of grouped erythematous nodules was apparent 10 days after partial excision of the lesion.

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Figure 2.
Microscopic Features

Hematoxylin-eosin (A-C) and Ki-67–stained (D and E) specimens. A and B, Pyogenic granuloma (A) overlying a deep capillary congenital hemangioma proliferation (B) with intervening stroma containing fibrosis with entrapped capillaries (original magnifications ×40). C, Superficial lobular capillary proliferation with a collarette of scale, with dermal fibrosis and entrapped capillaries; a deeper collection of capillaries is seen in the deep dermis and subcutaneous tissue (original magnification ×4). D and E, Staining with Ki-67 demonstrated an increased mitotic index in the superficial component (D) compared with the deep one (E) (original magnifications ×40 [D] and ×20 [E]).

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