PMC4076627_01
Clinical intraoral image of the exophytic lesion in relation to lingual area.
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F1
The chief complaint was a growing mass on the floor of the mouth for more than one year, which increased in size in the last weeks (Fig. 1).
Clinical intraoral image. The lesion was pedunculated involving the lingual mucogingival line and inserted on the keratinized mucosa.
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F2
An exophytic kidney-shaped lesion with a lobular contour and a glossy gray to reddish-purple surface measuring 25 to 30 mm in diameter was located in the anterior lingual right jaw, inserted through a pedunculated base on the keratinized mucosa also involving the mucogingival line (Fig. 2).
Macroscopic appearance of the excised lesion. Notice the multilobular base around the pedunculated area.
. (b). Clinical intraoral image. Notice a light tumefaction evidenced on the right sublingual area, immediately after the mass excision.
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F3
After the excision of this pedunculated mass, a light and asymptomatic tumefaction was clearly evidenced on the right sublingual area probably related with the compressive effect on the right salivary duct (Fig. 3a, b).
Microscopic appearance. Under an ulcerated surface there is an extensive granulation tissue reaction characterized by abundant small size vessels arranged perpendicularly to surface. At the bottom of the image, the characteristic appearance of pyogenic granuloma can be seen on the right (H&E, original magnification 10x).
. (b). At a higher power, the typical histologic features of pyogenic granuloma consist in a proliferation of capillary sized vessels arranged surrounding larger vessel structures producing its typical lobular distribution. There is stromal fibrosis dissecting between the capillary lobules. (H&E, original magnification 20x).
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F4
The final pathological diagnosis based on the microscopic findings was a pyogenic granuloma-lobular capillary hemangioma (Fig. 4a, b).