Case #33 Discussion

Summary: The patient complains of a well-circumscribed, non-tender, compressible, easily bleeding soft tissue enlargement on the right upper lip of ten days duration.  The patient reports injuring the area shortly before he first noticed it and states that the lesion is growing larger in size.  Clinically, it is found to have a crust which is rough to palpation and rubs off with firm pressure.  The portion of the lesion not covered by a crust blanches upon pressure. Lesions to Exclude from Differential Diagnosis: The lesion is described as a soft tissue enlargement.  It has a rapid growth rate and is associated with injury, which are features of reactive lesions.  However, the lesion is well-circumscribed, non-tender, persistent and progressive and should be classified as a tumor.    Within the category of tumors, malignant tumors and soft tissue cysts may be excluded.  Malignant tumors are excluded because these lesions infiltrate into underlying structures and are more likely to be painful.  Soft tissue cysts may also be eliminated because they grow slowly and do not blanch nor bleed easily. Benign epithelial tumors and benign salivary gland tumors can be eliminated because these do not blanch or bleed easily. Within the category of benign mesenchymal tumors peripheral ossifying fibroma, and peripheral giant cell granuloma can be excluded based on their location.  Leiomyoma may be eliminated because they grow slowly.  Fibroma, rhabdomyoma, lipoma, neurofibroma, schwannoma, granular cell tumor are excluded because they grow slowly and do not blanch or bleed easily.  Hemangioma and lymphangioma can be excluded because these are congenital and only grow rapidly during the first few years of life.  Neuroma can be eliminated because they are firm, tender to palpation, grow slowly, and do not blanch or bleed easily.  Congenital epulis is excluded because they are congenital and occur on the gingiva.  A benign, rapidly growing, easily bleeding, blanching tumor on the lip is suggestive of pyogenic granuloma. Final Diagnosis: Pyogenic Granuloma Management: Treatment is excisional biopsy and microscopic diagnosis.  The lesion may recur but is completely benign and has an excellent prognosis.