Evaluation And Pathological Analysis Of Pyogenic Granuloma Treated With Surgical Excision

Background:Pyogenic granuloma(PG),also known as lobular capillary hemangioma(LCH),is a benign angioproliferative tumor that usually occurs in the skin or mucosa of exposed areas such as the head and face,hands and feet.The pathogenesis is still unclear,and possible triggers include local trauma,drug application,sex hormone levels,pre-existing vasculopathy,etc.The lesion often increases rapidly within weeks to months after onset,along with superficial ulceration and bleeding tendency,which seriously affect the appearance and QOL of patients and require prompt intervention.Since it was first reported in 1897,many therapeutic procedures have been applied in clinical practice.Besides surgical treatment,there are various non-surgical treatments including cryotherapy,cautery,drugs,laser,sclerotherapy,and so on.It has been found in clinical applications that these treatments all achieve certain clinical efficacy,but all carry the risk of recurrence and adverse effects,thus causing some difficulties in medical decision making.Previous pathological studies on PG mainly focused on the histological features of the lesions and their differentiation from other tumors of vascular origin,and the involvement level of dysplastic capillaries in the lesions was rarely reported.However,the level of involvement of the lesion is one of the important bases for the choice of treatment,which is of great research value.Objective:In part one,the effectiveness,recurrence,occurrence of adverse effects and patient satisfaction of surgical resection for PG were observed,and the application of plastic surgical techniques in PG treatment was investigated.In part two,the involvement level of dysplastic capillaries in pathological tissue specimens of PG was investigated,and the advantages of surgical excision for PG treatment were analyzed pathologically to provide references for clinical practice.Methods:In part one,the information of patients with PG who visited the Department of plastic and aesthetic surgery,Shandong provincial hospital from January 2015 to January 2021 was collected.All patients were treated with surgical excision using plastic surgical techniques,and the effectiveness of treatment,recurrence,occurrence of adverse effects were evaluated in postoperative follow-up.Incisional scars were evaluated using the Vancouver Scar Scale(VSS),and Visual Analog Scale(VAS)was used to investigate patient satisfaction with scar appearance.In part two,by reviewing the database of the Department of pathology of Shandong Provincial Hospital,we collected information on all patients who were pathologically diagnosed with PG from January 2015 to January 2021,and HE stained images of pathological sections of patients were collected.Based on the histological grade of dysplastic capillary involvement in the lesions,the cases of cutaneous PG were divided into three groups:superficial and middle dermis group,deep dermis group,and subcutaneous tissue group.The proportion of each group was counted and its effect on treatment method was analyzed.Results:In part one,a total of 17 cases were collected,of which three cases were eliminated due to loss to follow-up.The remaining 14 cases were followed up for 6-57 months with a median follow-up of 20.6 months.Surgical excision was curative in 100%of 14 patients without recurrence and obvious adverse effects,with an average of 0.6 points in the VSS score for the incision and 9 points in the patient satisfaction with scar appearance.In part two,a total of 242 cases were collected of which three cases were removed due to section damage.Of the remaining 239 cases,124(51.88%)were male and 115(48.12%)were female,with a mean age of 39.64± 19.75 years.Among them,there was a predominance of male patients in the age group of 20 years and younger(74.47%)and a predominance of female patients in the age group of 21-40 years(61.33%).When grouped by site of onset,94(39.33%)were located in the skin and 145(60.67%)in the mucosa,with a higher proportion of mucosal cases among female patients(67.83%).Of the 94 cutaneous cases,2(2.25%)were in the superficial and middle dermis group,84(94.38%)were in the deep dermis group and 3(3.37%)were in the subcutaneous tissue group.Five cases which could not be judged were removed.Conclusion:1.Surgical resection for PG has a definite efficacy,low recurrence rate and few adverse effects,which deserve to be promoted in the clinic.2.Using plastic surgical techniques to treat PG,postoperative scars are not obvious and patient satisfaction is high,which further expands the application of surgical resection in treatment of PG.3.In cutaneous PG,intralesional dysplastic capillaries usually involve the deep dermis and a few lesions can involve the subcutaneous tissue layer.4.Surgical excision allows complete removal of lesions in the deep dermis or subcutaneous tissue,minimizing the rate of postoperative recurrence.