Research progress and misdiagnosis of pyogenic granuloma

doi:10.3760/cma.j.issn.1007-1245.2022.01.036

Abstract

Abstract: Pyogenic granuloma is a benign, acquired vascular tumor with nodular vascular hyperplasia, mild trauma, and easy bleeding as the main clinical manifestations. It is not a true tumor, and can be further diagnosed clinically by asking medical history, clinical manifestations, dermoscopy and histopathological examination and other auxiliary means.Due to its clinical manifestations of bright red or brown-red papular lesions, it is easy to be confused with some vascular and neoplastic skin diseases, and it is easy to be misdiagnosed when clinicians are inexperienced in the diagnosis of this disease. From 1992 to 2021, 18 misdiagnosis literatures of pyogenic granuloma were published in Chinese academic journals, with a total of 34 cases and more than 10 misdiagnosed diseases; many of them were misdiagnosed as true hemangioma, basal cell carcinoma, non-pigmented melanoma, eccrine poroma, gangrene, common wart, clear cell acanthoderma, etc. In order to reduce the misdiagnosis of pyogenic granuloma by clinicians in the future, we should further strengthen the understanding of its clinical manifestations and the use of necessary auxiliary examinations, so as to avoid the pain caused by misdiagnosis and mistreatment.

Key words: Pyogenic granuloma, Misdiagnosis, Differential diagnosis

摘要： 化脓性肉芽肿是一种良性、后天性以结节状血管增生、轻度外伤即易出血为主要临床表现的血管性肿瘤，并非真性肿瘤。临床上可通过询问病史、临床表现，以及皮肤镜和组织病理学检查等辅助手段进行进一步确诊。由于其临床表现为鲜红色或棕红色丘疹损害，易与一些血管性及肿瘤性的皮肤病混淆，在临床医生对该病的鉴别诊断经验不足的情况下，容易造成误诊。自1992—2021年发表在中文学术期刊的化脓性肉芽肿误诊文献18篇，累计误诊病例34例，误诊病种10余种，其中较多误诊为真性血管瘤、基底细胞癌、无色素性黑色素瘤、小汗腺汗孔瘤、坏疽病、寻常疣、透明细胞棘皮瘤等。为减少今后临床医生对化脓性肉芽肿的误诊，应进一步加强对其临床表现的认识及必要辅助检查的运用，避免误诊误治给患者带来的病痛。

关键词: 化脓性肉芽肿, 误诊, 鉴别诊断

Liu Yue. Research progress and misdiagnosis of pyogenic granuloma[J]. International Medicine and Health Guidance News, 2022, 28(1): 140-144.

刘悦. 化脓性肉芽肿的研究进展及误诊概况分析[J]. 国际医药卫生导报, 2022, 28(1): 140-144.

References

[1] 张颂,Mohammad Alashka,徐俊涛,等.化脓性肉芽肿的皮肤镜特征[J].中国麻风皮肤病杂志,2017,33(3):146-148.

[2] 李晓辉,翁智胜,彭洁雯,等.脂溢性角化病108例临床、病理及误诊分析[J].临床误诊误治,2020,33(8):27-30.DOI:10.3969/j.issn.1002-3429.2020.08.007.

[3] Allen R, Shah K, Jayanth A. Slam dunk diagnosis: pyogenic granuloma after basketball injury[J]. J Emerg Med, 2021,60(4):e95-e96. DOI: 10.1016/j.jemermed.2020.11.042.

[4] Romero-Morales VA, Marchese A, Miserocchi E, et al. Pyogenic granuloma after cosmetic eye whitening[J]. Arch Soc Esp Oftalmol (Engl Ed), 2021,96(2):89-92. DOI: 10.1016/j.oftal.2020.06.034.

[5] 臧艳姿,郭晓楠,董长宪,等.软腭特殊肉芽肿性血管瘤一例[J].中华医学杂志,2020,100(14):1115-1116.DOI:10.3760/cma.j.cn112137-20190819-01848.

[6] Luna-Ceron E, Gómez-Gutiérrez AK, Gonzalez-Hernandez C, et al. An uncommon presentation of pyogenic granuloma[J]. Cureus, 2021,13(1):e12509. DOI: 10.7759/cureus.12509.

[7] 王蓬鹏,张亚梅.婴儿咽部肉芽肿型血管瘤的药物治疗与监护[J].中国医院用药评价与分析,2011,11(12):1140-1142. DOI: 10.14009/j.issn.1672-2124.2011.12.020.

[8] 常晶.钝剥联合治疗化脓性肉芽肿的临床疗效分析[J/CD].临床医药文献电子杂志,2020,7(34):1,4. DOI:10.16281/j.cnki.jocml.2020.34.001.

[9] Sharma S, Shah JS, Asrani VK, et al. The Sclerotherapy-an efficacious approach in the management of vascular lesions and pyogenic granuloma: case series with literature review[J]. Indian J Otolaryngol Head Neck Surg, 2021,73(2):167-173. DOI: 10.1007/s12070-020-01960-4.

[10] Calado R, Calvão J, Pereira S, et al. Pyogenic granuloma: a new therapeutic role for salt?[J]. J Paediatr Child Health, 2021,57(3):459-460. DOI: 10.1111/jpc.15375.

[11] 张晨阳,倪文琼,段世萍,等.1064 nm Gentle YAG激光治疗21例复发性化脓性肉芽肿的临床分析[J].中国中西医结合皮肤性病学杂志,2020,19(5):413-414.DOI:10.3969/j.issn.1672-0709.2020.05.005.

[12] 李富利,蔡艳桃,黄惠珍,等.自凝刀射频联合CO2激光治疗化脓性肉芽肿的临床观察[J].皮肤病与性病,2020,42(4):570-572.DOI:10.3969/j.issn.1002-1310.2020.04.057.

[13] Fattore D, Di Guida A, Detoraki A, et al. Successful treatment of eruptive pyogenic granuloma with propranolol[J]. Dermatol Ther, 2021,34(4):e14998. DOI: 10.1111/dth.14998.

[14] Lee M, Sheilagh Maguiness.Infantile and congenital hemangiomas: natural history, complications, and when and how to treat[J]. Vascular Annmalies,2020,25(6):41-61.DOI:10.1007/978-3-030-25624-1_5.

[15] 曾诏群,司义湘,梁晓媚,等.面部基底细胞癌改良根治联合局部旋转皮瓣的临床美容研究[J].国际医药卫生导报,2019,25(13):2052-2054.DOI:10.3760/cma.j.issn.1007- 1245.2019.13.012.

[16] 尹逊国,牛蕊仙,李冬青,等.62例基底细胞癌误诊的临床及组织病理分析[J].皮肤病与性病,2020,42(5):634-636.DOI:10.3969/j.issn.1002-1310.2020.05.004.

[17] 韦海鹏,詹松,朱庆安,等.80例基底细胞癌误诊病人情况及组织病理研究[J].皮肤病与性病,2021,43(2):252-253.DOI:10.3969/j.issn.1002-1310.2021.02.045.

[18] Zaballos P, Carulla M, Ozdemir F, et al. Dermoscopy of pyogenic granuloma: a morphological study[J]. Br J Dermatol, 2010,163(6):1229-1237. DOI: 10.1111/j.1365-2133.2010.10040.x.

[19] Yang DD, Salciccioli JD, Marshall DC, et al. Trends in malignant melanoma mortality in 31 countries from 1985 to 2015[J]. Br J Dermatol, 2020,183(6):1056-1064. DOI: 10.1111/bjd.19010.

[20] Phillips M, Greenhalgh J, Marsden H, et al. Detection of malignant melanoma using artificial intelligence: an observational study of diagnostic accuracy[J]. Dermatol Pract Concept, 2019,10(1):e2020011. DOI: 10.5826/dpc.1001a11.

[21] Hasan A, Nafie K, Monazea K, et al. A rare case of recurrent eccrine poroma underlying gluteal abscess[J]. Int J Surg Case Rep, 2020,75:29-31. DOI: 10.1016/j.ijscr.2020.08.042.

[22] Wang Y, Liu M, Zheng Y, et al. Eccrine poroma presented as spindle-shaped plaque: a case report[J]. Medicine (Baltimore), 2021,100(20):e25971. DOI: 10.1097/MD.0000000000025971.

[23] 何月,李林烨,刘芳芳,等.小汗腺汗孔癌的临床研究进展[J].内蒙古医学杂志,2021,53(6):701-704.DOI:10.16096/J.cnki.nmgyxzz.2021.53.06.017.

[24] 喻标,杨庆华,赵强,等.Spitz痣25例临床病理分析[J].中国麻风皮肤病杂志,2018,34(9):520-523,527.

[25] 马琳.儿童皮肤病学[M].北京:人民卫生出版社,2014:335.

[26] Usmani A, Qasim S. Clear cell acanthoma: a review of clinical and histologic variants[J]. Dermatopathology (Basel), 2020,7(2):26-37. DOI: 10.3390/dermatopathology7020005.

[27] 赵文军,刘冬梅,黄池清,等.透明细胞棘皮瘤[J].临床皮肤科杂志,2020,49(10):577-579.DOI:10.16761/j.cnki.1000- 4963.2020.10.001.

[28] 吴倩,张志勇.56例角化棘皮瘤临床分析[J].中国麻风皮肤病杂志,2021,37(5):305-307.DOI:10.12144/zgmfskin202105305.

[29] Kwiek B, Schwartz RA. Keratoacanthoma (KA): an update and review[J]. J Am Acad Dermatol, 2016,74(6):1220-1233. DOI: 10.1016/j.jaad.2015.11.033.

[30] Ertop Doğan P, Akay BN, Okçu Heper A, et al. Dermatoscopic findings and dermatopathological correlates in clinical variants of actinic keratosis, Bowen's disease, keratoacanthoma, and squamous cell carcinoma[J]. Dermatol Ther, 2021,34(3):e14877. DOI: 10.1111/dth.14877.

[31] Kossard S. Keratoacanthoma, committed stem cells and neoplastic aberrant infundibulogenesis integral to formulating a conceptual model for an infundibulocystic pathway to squamous cell carcinoma[J]. J Cutan Pathol, 2021,48(1):184-191. DOI: 10.1111/cup.13861.

[32] Fraga GR, Chow P. Plasmacytoid dendritic cells in keratoacanthoma and squamous cell carcinoma: a blinded study of CD123 as a diagnostic marker[J]. J Cutan Pathol, 2020,47(1):17-21. DOI: 10.1111/cup.13573.

[33] Panagiotopoulos A, Kyriazis N, Polychronaki E,et al. The effectiveness of cryosurgery combined with curettage and electrodessication in the treatment of keratoacanthoma: a retrospective analysis of 90 cases[J]. Indian J Dermatol, 2020,65(5):406-408. DOI: 10.4103/ijd.IJD_202_18.