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Lingual Pyogenic Granuloma Gravidarum Sohini Bhattacharya, MD, Sanjay Kumar Bhattacharyya, MS, Bijan Patua, MS Department of Gynecology & Obstetrics, North Bengal Medical College, Darjeeling, India [ Rev Obstet Gynecol. 2013;6(2):46-47 doi: 10.3909/riog0209]
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Key words Pregnancy tumor • Pyogenic granuloma
25-year-old primigravid Indian woman presented with a fleshy swelling of 2 × 2 cm at the tip of her tongue in the sixth month of gestation. It was soft in consistency, vascular, and painless. She reported that it was gradually increasing in size. With a provisional diagnosis of pyogenic granuloma, she was put on conservative management with careful oral hygiene and use of soft toothbrushes. The mass increased in size until it was 3 3 3 cm at the time of delivery (left). She underwent caesarean delivery at 39 weeks of gestation for an obstetrical reason and delivered a healthy newborn. After delivery there was a steady reduction in the size of the
lingual mass. After 7 months the growth had shrunk to the size of mustard seed (right). Pregnancy tumor (also known as pyogenic granuloma and granuloma gravidarum) can be found in up to 5% of pregnant women and should be considered if any fleshy mass is found in oral or aural tissue, the nasal fossa, or on the skin of a gravid woman.1-4 It is a benign inflammatory hyperplasia that presents as a tumor-like overgrowth. Sex hormone imbalance has been postulated as a cause of the increased incidence of pyogenic granuloma in the antenatal period. The same etiologic factor may result in its increased prevalence in oral contraceptive pill users.1 The
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Lingual Pyogenic Granuloma Gravidarum majority of these growths require simple, conservative care. Automatic shrinkage of the lesion in the postpartum period and a high recurrence rate following removal in the gravid state discourages the choice of routine excision in the antenatal period. Excision is only performed in special circumstances, when there is major interference of speech or mastication, or when an aesthetic complication
exists.1 Bleeding episodes following trauma may create an emergency situation, which can be managed with firm compression, desiccation of bleeders, blood transfusion, or (very rarely, such as in cases of eclampsia) pregnancy termination.1,5 Maintenance of oral hygiene, removal of dental plaques, and use of soft toothbrushes in the antenatal period are the routine preventive measures.6
References 1. 2.
Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. J Oral Sci. 2006;48:167-175. Choudhary S, MacKinnon CA, Morrissey GP, Tan ST. A case of giant nasal pyogenic granuloma gravidarum. J Craniofac Surg. 2005;16:319-321. Fenton JE, Timon CI, McShane DP. Lingual granuloma gravidarum. Otolaryngol Head Neck Surg. 1996;114:682-683. Venugopal S, Shobha KS, Netravathi TD. Pyogenic granuloma-a case report. J Dent Sci Res. 2010;1:80-85. Wang PH, Chao HT, Lee WL, et al. Severe bleeding from a pregnancy tumor. A case report. J Reprod Med. 1997;42:359-362. Sills ES, Zegarelli DJ, Hoschander MM, Strider WE. Clinical diagnosis and management of hormonally responsive oral pregnancy tumor (pyogenic granuloma). J Reprod Med. 1996;41:467-470.
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