Endoscopy 2022; 54(11): E635-E636
DOI: 10.1055/a-1730-4529
E-Videos

Gastric pyogenic granuloma: rare entity, usual therapy

1   Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
,
Elisa Righi
2   Anatomic Pathology Unit, AUSL Bologna, Bologna Metropolitan Department of Pathology, Bologna, Italy
,
Emanuele Dabizzi
1   Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
,
Stefania Ghersi
1   Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
,
Pasquale Apolito
1   Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
,
Stefano Landi
1   Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
,
1   Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
› Author Affiliations
 

Lobular capillary hemangioma, known as pyogenic granuloma, is a benign vascular tumor that generally appears on the skin or in the oral cavity but rarely occurs in the gastrointestinal tract, where it can cause bleeding [1]. Although gastric pyogenic granuloma is rarely reported in the literature, (up to 2016, approximately 50 cases of gastrointestinal pyogenic granuloma in the English literature had been indexed on MEDLINE, including a few cases of gastric involvement), the actual incidence is probably higher [2] [3].

The endoscopic appearance of pyogenic granuloma is usually a single polypoid lesion, smooth and ulcerated; the color ranges from bluish to reddish with a superficial white or opaque film covering. Resection of pyogenic granuloma is necessary in patients with anemia, but post-resection bleeding is a potential complication. The lesions typically involve the mucosa but may extend to the deep layers; thus, preoperative endoscopic ultrasonography is recommended [1] [4] [5].

Histopathologically, pyogenic granuloma is a hemangioma characterized by a lobule-like growth of capillaries with enlarged vascular endothelial cells and inflammatory cell infiltration in the stroma. Granulation tissue may also be present; the main pathological differential diagnosis of pyogenic granuloma includes bacillary angiomatosis, Kaposi’s sarcoma, or inflammatory and/or hyperplastic polyps [1] [3].

We report a case of a 78 year-old Caucasian woman with a medical history significant for ibuprofen use admitted to our department for anemia and melena requiring transfusion. Esophagogastroduodenoscopy revealed a nearly 20-mm pedunculated polyp, strongly hyperemic with a superficial white film, in the gastric body ([Fig. 1]). Endoscopic ultrasonography showed mucosal involvement without deep infiltration ([Fig. 2]).

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Fig. 1 20-mm polypoid lesion with a superficial white film covering the head.
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Fig. 2 Endoscopic ultrasonography evidence of a hypoechoic lesion arising from the second wall layer with preserved wall layers and no deep infiltration.

We removed the polyp using endoscopic mucosal resection, lifting the lesion with a solution of indigo carmine and epinephrine; in addition, multiple clips were used to close the defect to prevent bleeding ([Video 1]). Histology demonstrated foveolar hyperplasia and lobulated capillary hemangioma, characteristic of pyogenic granuloma ([Fig. 3], [Fig. 4]). Her refractory anemia improved after the procedure.

Video 1 Gastric pyogenic granuloma effectively removed by endoscopic snare resection.


Quality:
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Fig. 3 Numerous thin-walled capillaries of different size lined with endothelial cells are separated by inflammatory stroma (hematoxylin & eosin, × 40).
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Fig. 4 ERG positivity, a specific marker for endothelial cells, in contrast with gastric glands, with foveolar hyperplasia surrounding the lesion (immunohistochemistry, × 20)

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Competing interests

Dr. Cennamo is a consultant for and has received speaker fees and travel grants from Olympus Italia, Olympus Europa, Euromedical, and Novità Medicali. All other authors declare that they have no conflict of interest.


Corresponding author

Marco Bassi, MD
Gastrointestinal and Interventional Endoscopy Unit
Surgical Department, AUSL Bologna
Maggiore Hospital
Largo Nigrisoli 2
40139 Bologna
Italy   
Fax: +39-05-1647814   

Publication History

Article published online:
04 February 2022

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Zoom Image
Fig. 1 20-mm polypoid lesion with a superficial white film covering the head.
Zoom Image
Fig. 2 Endoscopic ultrasonography evidence of a hypoechoic lesion arising from the second wall layer with preserved wall layers and no deep infiltration.
Zoom Image
Fig. 3 Numerous thin-walled capillaries of different size lined with endothelial cells are separated by inflammatory stroma (hematoxylin & eosin, × 40).
Zoom Image
Fig. 4 ERG positivity, a specific marker for endothelial cells, in contrast with gastric glands, with foveolar hyperplasia surrounding the lesion (immunohistochemistry, × 20)