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CASE REPORT
Year : 2020  |  Volume : 21  |  Issue : 2  |  Page : 145-146

Recurrent pyogenic granuloma with satellitosis in a 5-year-old child


1 Dr. Saoji Skin Clinic, Nagpur, Maharashtra, India
2 Department of Dermatology, HBT Medical College and Dr. RN Cooper Hospital, Mumbai, Maharashtra, India

Date of Submission08-Apr-2019
Date of Acceptance01-Jan-2012
Date of Web Publication01-Apr-2020

Correspondence Address:
Vikrant A Saoji
1st Floor, Midas Heights, Central Bazar Road, Ramdaspeth, Nagpur - 440 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_81_19

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  Abstract 


A 5-year-old male child presented with multiple asymptomatic red raised lesions over the left lateral side of his abdominal wall since 2 years. Cutaneous examination revealed multiple bright red, nontender, dome-shaped papules, and nodules arranged discretely. At few places, the lesions coalesced to form plaques with crusting on the surface. The lesions appeared to be arranged in a peculiar manner; with an increased concentration of the lesions in the vicinity of an atrophic central scarred area (of previous surgery) and few satellite discrete papules and nodules away from it. The differential diagnoses of pyogenic granuloma (PG), epithelioid hemangioendothelioma, and bacillary angiomatosis were considered. Histopathological examination from a nodule revealed angiomatous tissue composed of dilated thin-walled capillaries and groups of poorly canalized vascular tufts located in the upper and mid dermis suggestive of PG. A diagnosis of recurrent PG with satellitosis in a 5-year-old child was made. This case is described for the rarity of the condition in children and to emphasize the alarming presentation of a benign condition.

Keywords: Benign, pyogenic granuloma, recurrent, satellite lesions, vascular proliferations


How to cite this article:
Saoji VA, Rambhia KD, Goyal MM. Recurrent pyogenic granuloma with satellitosis in a 5-year-old child. Indian J Paediatr Dermatol 2020;21:145-6

How to cite this URL:
Saoji VA, Rambhia KD, Goyal MM. Recurrent pyogenic granuloma with satellitosis in a 5-year-old child. Indian J Paediatr Dermatol [serial online] 2020 [cited 2020 May 26];21:145-6. Available from: http://www.ijpd.in/text.asp?2020/21/2/145/281737




  Introduction Top


Pyogenic granuloma (PG) or lobular capillary hemangiomas are common, benign vascular proliferations affecting the skin and mucous membranes. Although recurrence after treatment is known; the occurrence of multiple satellite lesions of PGs after complete removal with any surgical modality is an extremely rare entity.


  Case Report Top


A 5-year-old male child presented with multiple asymptomatic red raised lesion over the left lateral side of the abdominal wall since 2 years. There was no history of pain, though the patient complained of occasional bleeding after minor trauma. It started as a single lesion over the abdominal wall. There was a history of excision twice before the patient presented to us. Cutaneous examination revealed multiple bright red, nontender, soft to firm dome-shaped papules, and nodules arranged discretely. At few places, the lesions coalesced to form plaques with crusting on the surface. The lesions appeared to be arranged in a peculiar manner; with an increased concentration of the lesions in the vicinity of an atrophic central scarred area (of previous surgery) and few satellite discrete papules and nodules away from it [Figure 1]. There were no other cutaneous lesions elsewhere on the body. The general and systemic examination was within normal limits. The differential diagnoses of PG, epithelioid hemangioendothelioma, and bacillary angiomatosis were considered. Histopathological examination from a nodule revealed angiomatous tissue composed of dilated thin-walled capillaries and groups of poorly canalized vascular tufts located in the upper and mid dermis. The lobules were surrounded by a fibromyxoid stroma. An epithelial collarette was seen in the periphery of the area overlying the capillary lobules [Figure 2]. These findings were suggestive of PG. A diagnosis of recurrent PG with satellitosis in a 5-year-old child was made.
Figure 1: Bright red dome-shaped papules and nodules

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Figure 2: Well-circumscribed mass of proliferating capillaries with an epithelial collarette (H&E, 40×)

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  Discussion Top


PG or lobular capillary hemangiomas are common, benign vascular proliferations affecting the skin and mucous membranes. They are frequently located on the head and neck, upper limb.[1] Most PGs occur spontaneously, but trauma, burns, localized viral infections, or insect bites and pregnancy are believed to cause the formation of PG. Clinically, the lesions appear as solitary red-to-violaceous pedunculated or sessile papules or nodules that may easily bleed, crust, or ulcerate, with a peripheral collarette of scale. Histopathologically, the lesions demonstrate a well-circumscribed mass of proliferating capillaries in an edematous stroma. An epithelial collarette is seen enclosing the angiomatous tissue. Treatment strategies include surgical excision, curettage, cryotherapy, cautery, and lasers.[2]

Recurrence after treatment is seen in 16%–50% of cases.[3] However, the recurrence of PG as multiple satellite lesions is extremely rare. Recurrent PGs with satellitosis are also known as Warner and Wilson–Jones syndrome.[4] In a series of 11 cases, Warner and Wilson–Jones found that the majority of cases of recurrent PG with satellitosis occurred on the trunk, frequently situated over the scapula. This condition is characterized by multiple PGs within or at the periphery of the previously treated primary lesion. Satellite lesions appeared either alone or in association with recurrence of the original lesion and tend to be larger and more numerous near the scar whereas further away smaller and fewer lesions were seen. The mean duration of the recurrence was 1 month–4 months following the treatment of the primary lesion. Histologically, satellite PGs generally resembled the original lobular capillary hemangiomas, although some smaller recurrent papules resembled simple capillary hemangiomas and in some of the largest recurrent tumors, there was deep extension to the level of the subcutaneous fat.[4] Its exact pathogenesis is unknown, although the release of proangiogenic factors, such as vascular endothelial growth factor, after trauma to the initial lesion could play a role.

Treatment modalities include surgical excision, curettage, electrocautery, cryotherapy, sclerotherpy laser, pulsed dye laser, systemic steroids, radiotherapy, and intense pulsed light, but the lesions may recur.[5] Spontaneous involution occurring within 6–12 months has also been described.[6]

This case is reported due to the rarity of the condition in children and to emphasize the alarming presentation of a benign condition.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Patrice SJ, Wiss K, Mulliken JB. Pyogenic granuloma (lobular capillary hemangioma): A clinicopathologic study of 178 cases. Pediatr Dermatol 1991;8:267-76.  Back to cited text no. 1
    
2.
Paradela S, del Pozo J, Martínez W, Fernández-Jorge B, Rodriguez-Lozano J, Yebra-Pimentel T, et al. Pyogenic granuloma: Satellitosis after carbon dioxide laser vaporization resolved with an intense pulsed light system. Dermatol Surg 2007;33:104-8.  Back to cited text no. 2
    
3.
Dillman AM, Miller RC, Hansen RC. Multiple pyogenic granulomata in childhood. Pediatr Dermatol 1991;8:28-31.  Back to cited text no. 3
    
4.
Warner J, Jones EW. Pyogenic granuloma recurring with multiple satellites: A report of 11 cases. Br J Dermatol 1968;80:218-27.  Back to cited text no. 4
    
5.
Paradela S, del Pozo J, Martínez W, Fernández-Jorge B, Rodriguez-Lozano J, Yebra-Pimentel T, et al. Pyogenic granuloma: Satellitosis after carbon dioxide laser vaporization resolved with an intense pulsed light system. Dermatol Surg 2007;33:104-8.  Back to cited text no. 5
    
6.
Blickenstaff RD, Roenigk RK, Peters MS, Goellner JR. Recurrent pyogenic granuloma with satellitosis. J Am Acad Dermatol 1989;21:1241-4.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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